Platelet-rich plasma inside the sternotomy wound reduces the incidence of sternal wound infections.

Despite the large choice of wide-spectrum antibiotic therapy, deep sternal wound infection (DSWI) following cardiac surgery is a life-threatening complication worldwide. This study evaluated that the use of platelet-rich plasma (PRP) applied inside the sternotomy wound would reduce the effect of sternal wound infections, both superficial and deep. Between January 2007 and January 2012, 1093 consecutive patients underwent cardiac surgery through median sternotomy. Patients were divided into two groups. Group B, the study group, included those who received the PRP applied inside the sternotomy wound before closure. Group A, the control group, included patients who received a median sternotomy but without the application of PRP. Antibiotic prophylaxis remained unchanged across the study and between the two groups. Occurrence of DSWI was significantly higher in group A than in group B [10 of 671 (1·5%) versus 1 of 422 (0·20%), P = 0·043]. Also, superficial sternal wound infections (SSWIs) were significantly higher in group A than in group B [19 of 671 (2·8%) versus 2 of 422 (0·5%), P = 0·006]. The use of PRP can significantly reduce the occurrence of DSWI and SSWI in cardiac surgery.

Impact of endothelial activation on infective and inflammatory complications after cardiac surgery in type II diabetes mellitus.

PURPOSE: Altered endothelial response has been described in diabetics after cardiac surgery. Infections and inflammatory organ damage often complicate the postoperative course. We evaluated endothelial/cytokine response (ECR) after cardiac surgery and its role on infective/inflammatory complications of type II diabetic patients. METHODS: Perioperative ECR of 60 diabetic patients (Group A) undergoing cardiopulmonary bypass was compared to that of 60 non-diabetics (Group B). Hemodynamics, endothelial markers [vascular endothelial growth factor (VEGF) and monocyte chemotactic protein-1 (MCP-1)], pro-inflammatory (IL-2, IL-6, IL-8) and anti-inflammatory cytokines (IL-10) were analyzed preoperatively (T0), at time of aortic declamping (T1), at ITU admission (T2), at 12 h (T3) and 24 h (T4) postoperatively. Postoperative infective/inflammatory complications were registered, and the related ECR was analyzed. RESULTS: Hemodynamics were comparable. No differences were found in perioperative IL-6 (p = 0.776) and IL-8 (p=0.660) between the 2 groups. However, the diabetics showed significantly higher endothelial activation (VEGF p = 0.0001, p = 0.0001 since T1 to T3; MCP-1 p = 0.0001, p<0.007 at T1, T3 and T4) with lower IL-10 (p = 0.0001, p<0.05 at T2, T3, T4) and lower IL-2 secretion (p = 0.0001, p < 0.0001 at T1, T2). Infections developed in 23.3% of the diabetics; inflammatory complications in 13.3%. Those developing infections showed significantly lower IL-2 (p = 0.042; p = .021 at T1 and T2) than patients without infections, whereas those with complicated inflammatory lung or renal injury had higher MCP-1 leakage (p = 0.006) with lower IL-10 (p = 0.005). CONCLUSIONS: The diabetics showed higher endothelial activation and lower antiinflammatory response to CPB compared to non-diabetics. Infections in diabetic patients correlated with depressed IL-2, while inflammatory complications correlated to higher endothelial activation and lower anti-inflammatory cytokine secretion.