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Cardiac Solutions

Myocardial Infarction

The goals of stem cell therapy in Cardiac areas are to improve the structural adaptation of the heart to myocardial infarction, regenerate ischemic and scarred myocardium, enhance cardiac function, and improve quality of life. One approach involves the intracoronary infusion of bone-marrow-derived autologous stem cells in patients with acute MI. Evidence suggests that stem cells “home,” or migrate, to the infarct zone even when infused. Stem cells have demonstrated promising effects on infarct size, left ventricular (LV) systolic function, and myocardial viability. Several clinical trials targeting heart disease have shown that adult stem cell therapy is safe, effective, and equally efficient in treating old and recent infarcts. Whether improvements can be attributed to differentiation of stem cells into cardiac myocytes, angiogenesis, secretion of growth factors or some other mechanism, is unclear.

“Cardiac surgery combined with stem cell therapy may enhance angiogenesis in difficult to treat patients with diffuse coronary artery disease that have no conventional revascularization options.” Allen: World Cardiothoracic Society, Indonesia, March 2008

Sternal Closure

While the pathology of mediastinitis is most likely multi-factorial, the most common pathogens include staphylococcus epidermidis and staphylococcus aureus. Platelet gel is produced from a small sample of the patient’s blood collected prior to surgery. The blood is then centrifuged yielding a platelet rich plasma component. This platelet rich plasma is then combined with a thrombin activator and delivered in a spray or liquid application to the wound site. The use of autologous platelet gel may provide a potential prophylactic therapy that significantly reduces the chance of a sternal wound complication. Numerous studies have documented the benefits of this technology to significantly reduce the incidence of both superficial and deep sternal infection, as well as provide improved overall healing and hemostatic benefits.

Several platelet mediators have proven to enhance angiogenesis and collagen synthesis, including platelet derived growth factor (PDGF), platelet derived epidermal growth factor and transforming growth factor beta. Additionally, PDGF works to recruit monocytes, macrophages and fibroblasts to the wound site.

References - Cardiovascular

Hollenbeak, C, et al, The Clinical and Economic Impact of Deep Chest Surgical Site Infections Following Coronary Artery Bypass Graft Surgery, Chest, 2000; 118:397-402

Ridderstolpe, L, et al, Superficial and Deep Sternal Wound Complications: Incidence, Risk Factors and Mortality, European Journal of Cardiothoracic Surgery, 2001; 20:1168-1175

Hollenbeak, C, et al, Nonrandom Selection and the Attributable Cost of Surgical-Site Infections, Infection Control, 2002; 23:177-182

Mogan, C, et al, Rationale of Platelet Gel to Augment Adaptive Remodeling of the Injured Heart, Journal of Extracorporeal Technology, 2004; 36:191-196

National Nosocomial Infections Surveillance System Report, American Journal Infection Control, 2004, 32:480-485

Mazzucco, L, et al, The Use of Autologous Platelet Gel to Treat Difficult-To-Heal Wounds: A Pilot Study, Transfusion, 2004; 44:1013-1018

Englert, S, et al, Autologous Platelet Gel Applications During Cardiovascular Surgery: Effect on Wound Healing, Journal of Extracorporeal Technology, 2005; 37:148-152

Trowbridge, C, et al, Use of Platelet Gel and Its Effects on Infection in Cardiac Surgery, Journal of Extracorporeal Technology, 2005; 37:381-386

Olsen, M, et al, Risk Factors for Leg Harvest Surgical Site Infections after Coronary Artery Bypass Graft Surgery, Journal of Thoracic and Cardiovascular Surgery, 2003; 126:992-999

Vang, S, et al, Autologous Platelet Gel in Coronary Artery Bypass Grafting: Effects on Surgical Wound Healing, Journal of Extracorporeal Technology, 2007; 39:31-38

Associated Press, Medicare Won’t Pay for Hospital Mistakes, Washington Post, 2007; August 18

Smith, C, et al, Quality Assessment of Platelet Rich Plasma During Anti-Platelet Therapy, Perfusion, 2007; 22:41-50

Diez, C, et al, Risk Factors for Mediastinitis After Cardiac Surgery - A Retrospective Analysis of 1700 Patients, Journal of Cardiothoracic Surgery, 2007; 2:23

Khalafi, R, et al, Topical Application of Autologous Blood Products During Surgical Closure Following a Coronary Artery Bypass Graft, European Joural of Cardiothoracic Surgery, 2008; 04:026

Wehberg, K, et al, Intramyocardial Injection of Autologous Platelet Rich Plasma Combined with Transmyocardial Revascularization, Western Thoracic Surgical Association Poster Presentation, 2008; June 28

Gunaydin, S, et al, Clinical Impact and Biomaterial Evaluation of Autologous Platelet Gel in Cardiac Surgery, Perfusion, 2008; 00:1-8