Autologous Platelet Gel Increases Tissue Phagocytic Capacity 2.5x in Diabetic Cardiac Surgery Patients

Study combines biomaterial evaluation with clinical outcome data

In a 419-patient study presented at the poster sessions of the 2009 Society of Thoracic Surgeon (STS) Meeting, Serdar Gunaydin, MD sought to evaluate not only whether the use of platelet gel (PG) protects against sternal wound infection, but also why it would do so.

"Previous studies were not able to study the actual mechanism by which the platelet gel worked because the gel was applied to the inside of the chest before it was closed,” he explained. “So prior results were based only on external clinical observation.”

Combining biomaterial evaluation with the clinical data, Dr. Gunaydin and his co-authors concluded that PG application more than doubled the phagocytic capacity of the tissue in diabetic patients undergoing bilaterial thoracic artery grafting¹.

Using a cell culture method they first described in a study presented at the Annual Meeting of the American Academy of Cardiovascular Perfusion² in 2008, the authors determined that sternal subcutaneous tissue (fibroblasts) and endothelial cells from the aorta were both increased in number and enhanced in function after application of platelet gel.

“We believe that the results from the biomaterial evaluation were the most important data presented in this paper,” he claims.

In addition to the biomaterial evaluation, the study compared the length of hospital stay and incidence of wound-related complications in four groups of diabetic patients:

• Patients with bilateral internal thoracic artery (BITA) grafts and application of PG
• Patients with BITA grafts and no PG
• Patients with single ITA (SITA) grafts and application of PG
• Patients SITA grafts and no PG

Patients in the two arms of the study that received an application of PG experienced significantly fewer superficial sternal wound infections, deep sternal wound infections, sternal dehiscence, and reduced treatment period.

First presentation of topic at STS meeting

Dr. Gunaydin’s study represented the first time that the use of autologous platelet gel was featured in a presentation at an STS meeting.

He speculates that the growing cost of surgical complications, such as sternal infection, are driving the interest in autologous platelet gel.

"Like in the US, hospitals in many European countries must now pay the cost of complications resulting from cardiac surgery," he explains. Dr. Gunaydin has practiced surgery in Germany, Turkey, Japan and the U.S. "Most European governments cap the reimbursement of cardiac surgery and may no longer reimburse for complications."

"And of course, platelet gel is an attractive solution because it is autologous."

1 Autologous Platelet Gel for the Prevention of Sternal Wound Infection in Diabetic Patients Undergoing Bilateral Thoracic Artery Grafting. Gunaydin S et al. 45th Annual Meeting of the Society of Thoracic Surgeons 2009, San Francisco.

2 Clinical Impact and Biomaterial Evaluation of Autologous Platelet Gel in Cardiac Surgery. Perfusion 2008; 23: 179-186. Gunaydin S et al.