E-Posters

Bleeding and surgical wound infections after open heart surgery are associated with increased morbidity and mortality. These complications have devastating effects on patients' recovery and a substantial economic impact on healthcare providers; there remains an incentive to reduce the risk further. Platelet-rich plasma (PRP) is a source of growth factors and cytokines, which can promote tissue healing and regeneration. The aim of this study is to determine the effect of PRP on bleeding and surgical wound infection after cardiac surgery.

Evaluation of topical application of PRP in controling bleeding and sternal wound infection in cardiac surgery

34 patients were randomized into two groups; PRP group and control group. 30 ml of the patient’s autologous blood was centrifuged for 5 minutes to separate the RBCs from the plasma. The plasma was then centrifuged for 10 minutes; the precipitate is the PRP. Activation of PRP was done by adding 1ml of calcium gluconate to the syringe just before spraying the PRP in the operative field. After weaning the patient from cardiopulmonary bypass and before the insertion of sternal wires; the mediastinal cavity was irrigated with the PRP (30 ml of warm saline mixed with an equal amount of PRP) in group ‘A’ and saline only in group ‘B.’ Study endpoints were bleeding and blood transfusion.

Wound discoloration occurred in 11.8 % (2 cases) in the control group; however, no wound discoloration recorded in the PRP group with (P-value:0.145). Drainage (with mean drainage in control group was 473.53 ml &mean drainage in PRP group was 193.75 ml) and transfusion requirements (with mean transfusion requirements in control group was 1.5 pack &mean transfusion requirements in PRP group was 0.63 pack) were a statistically significant difference between the two groups in favor of the PRP group (P value<0.001).PRP depends on the enrichment of thrombocytes that release the growth factors PDGF, TGF ß1/ß2, EGF and IGF-I from their granules and this result in the formation of a blood clot.

Our results suggest that bleeding tendency, coagulation profile, the incidence of blood transfusion are better with the application of platelet-rich plasma. Wound discoloration was better with the application of platelet-rich plasma.

Amit N.Patel, Craig H.Selzman & Ganesh S.Kupati. Evaluation of autologous platelet rich plasma for cardiac surgery: outcome analysis of 2000 patients. Journal of Cardiothoracic Surgery 2016; 85:743-29.