1. PRP USE IN CARDIOTHORACIC SURGERY R. S. KHALAFI, M.D., FACS, FCCP DIRECTOR,CARDIOTHORACIC SURGERY NORTH TEX. AFFL. MED GROUP

2. Total for Treatment of One Mediastenitis Case $235,846.32

3. PATIENT PROFILE WITH MEDIASTENITIS 48 YEAR OLD WHITE MALE HISTORY OF HTN, HYPERLIPIDEMIA SMOKING, INSULIN DEPENDENT DIABETES SEVERE 3 VESSEL CORONARY ARTERY DISEASE PREVIOUS HEART ATTACK

4. HOSPITAL COURSE UNDERWENT 3 VESSEL BYPASS PURULENT DRAINAGE FROM STERNAL WOUND 5 DAYS AFTER THE SURGERY UNDERWENT REOPERATION FOR STERNAL DBRIEDEMENT AND CLOSURE

5. HOSPITAL COURSE REQUIRED 6 WEEKS OF VANCOMYCIN TREATMENT FOR MRSA INFECTION 3 WEEKS OF HOSPITALIZATION AND 3 WEEKS OF HOME HEALTH CARE REQUIRED 5 WEEKS OF OPEN WOUND DRESSING CHANGES

6. MEDIASTINITIS INFECTION OF THE STERNUM INCIDENCE OF MEDIASTENITIS IS 1-6% MOST DEVESTATING POST OPERATIVE COMPLICATION REQUIRES MULTIPLE OPERATIONS SOMETIMES REQUIRES RESECTION OF THE STERNUM WITH MUSCLE FLAP

7. MEDIASTINITIS

8. 2% RISK OF INFECTION IS QUOTED TO PATIENTS IF NOT DIAGNOSED EARLY WILL LEAD TO DEATH 100% OF THE TIME

9. WHY DO I DO IT OUT OF 450 CASES LAST YEAR WE HAD 5 MEDIASTINITIS AND NUMEROUS LEG INFECTIONS ONE DEATH FROM SEVERE SEPTECEMIA TREMENDOUS AMOUNT OF COST MANY CASES OF CLEAR DRAINAGE FROM THE WOUNDS

10. Technique 110ml of blood is drawn Two GPS disposables are processed - One for the sternum - One for the graft harvest site on the leg

11. After chest wires are put in but before tightening, half of the platelet rich plasma (PRP) is sprayed along the exposed sternal edges.

12. The wires are then tightened and the remaining PRP is sprayed over the subcutaneous tissue.

13. Platelet Poor Plasma (PPP) is then applied to each layer upon closure. Leave PPP is place and sew through PPP gel. Do not lap up after applying.

14. Platelet Rich Plasma (PRP) is delivered through a long, dual cannula and backfilled along the graft harvest site. PRP Application

15. After applying Platelet Rich Plasma (PRP) to the leg, apply the Platelet Poor Plasma (PPP) in the same fashion with a long, dual cannula tip. PPP Application

16. RESULTS 700 CASES TO DATE ONE CASE OF MEDIASTINITIS AND ONE LEG INFECTION RAPID WOUND HEALING EXTREMELY SMALL NUMBER WITH WOUND DRAINAGE

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