Use of Platelet Gel and Its Effects on Infection in Cardiac Surgery

Abstract

The use of plasmapheresis in cardiac surgery has failed to show an unequivocal benefit. However, the further processing of plasmapheresed blood to obtain a platelet-rich concentrate, termed platelet gel, may reduce patient susceptibility to infection through poorly understood mechanisms related to a combination of platelets, white blood cell content, and expedited wound healing. The purpose of the study was to retrospectively evaluate the incidence wound infections in patients undergoing cardiac surgery. Platelet gel (PG) patients (n = 382) received topical administration of a mixture of platelet concentrated plasma, 10% calcium chloride (5 mL), and bovine thrombin (5000 units). A control group (NoPG, n = 948) operated on concurrently with the treatment group did not receive PG, but otherwise received similar wound care. A historical control (HC, n = 929) included patients operated on before the availability of PG. After Institutional Review Board approval, 20 factors reported in the literature to predispose individuals for increased infection were recorded along with infections classified either as superficial or deep sternal according to the Society of Thoracic Surgeon criteria. All data were obtained from our institutional contribution to the Society of Thoracic Surgeon database. All adult (>19 years of age) patients undergoing cardiac surgery at our institution between October 2002 and June 2005 were included in this study (n = 2259). The incidence of superficial infection was significantly lower in the PG group (0.3%) compared both with the NoPG (1.8%) and HC (1.5%) groups (p < .05). There was a similar relationship found when comparing deep sternal wound infections (PG, 0.0% vs. NoPG, 1.5%; p < .029 and PG vs. HC, 1.7%; p < .01). In conclusion, the application of PG in patients undergoing cardiac surgery seems to confer a level of protection against infection, although the mechanisms of action remain to be elucidated.

Platelet‐rich plasma influence on the sternal wounds healing: A meta‐analysis

“…In the research that was utilised for the meta-analysis, 8961 CS persons were in the utilised researchers' starting point, 3663 of them were utilising PRP, and 5298 were control. [12][13][14][15][16][17][18][19][20][21][22] PRP had significantly lower SWI, deep SWI, and superficial SWI, compared to control in CS persons. However, when interacting with its values, caution must be taken since a low sample size of some of the nominated researchers was found for the comparisons in the meta-analysis (5 out of 11 <200 persons).…”

“…Eleven papers, published between 2005 and 2022, from a total of 1098 linked research that met the inclusion criteria were chosen for the research. [12][13][14][15][16][17][18][19][20][21][22] The consequences of these investigations are accessible in Table 2. 8961 CS persons were in the utilised researchers' starting point, 3663 of them were utilising PRP, and 5298 were control.…”

Autologous platelet gel in total knee arthroplasty: a prospective randomized study

“…Potential positive clinical effects of these findings are confirmed in a study on the combined use of platelet gel and fibrin sealant in TKA which showed a statistically significant lower incidence of postoperative wound infections and postoperative leakage in the treatment group [11]. In cardiac surgery, a statistically significant lower incidence of superficial wound infections and deep sternal postoperative infections was also observed in the APG group [42]. Furthermore, in acute and chronic cutaneous wounds, and in diabetic neuropathic foot ulcers, the application of autologous APG was concluded to enhance the standard treatment [8, 21, 27, 31, 32].…”

“…Autologous platelet gel (APG), prepared from a unit of autologous fresh whole blood, is a small volume of plasma containing high concentrations of platelets, growth factors, leucocytes, vaso‐active substances, mixed with thrombin. The use of APG has been advocated to improve haemostasis, range of motion, wound healing, and bone growth in a variety of surgical disciplines [2–4, 10–14, 17–19, 21, 34, 42, 45].…”

Platelet-Rich Plasma Combined With Skin Substitute for Chronic Wound Healing: A Case Report

“…There is also indication that PRP has infection-fighting properties. PRP has been shown to reduce the incidence of sternal infection (7), and it is now understood that platelets play a role in recruiting white blood cells (8) and release bactericidal factors (9). These revelations make PRP use in chronic wounds all the more attractive, because they are plagued by infection.…”