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Brandenburg an der Havel, Germany

Kuhnel R.-U.,Immanuel Klinikum Bernau | Muller T.,Immanuel Klinikum Bernau | Hartrumpf M.,Immanuel Klinikum Bernau | Erb M.,Immanuel Klinikum Bernau | Albes J.M.,Immanuel Klinikum Bernau
Kardiotechnik | Year: 2013

Objective: Left Ventricular Assist Devices (LVAD) are increasingly used for terminal heart insufficiency. The HeartWare® LVAD (HVAD) is one of the most implanted systems. Because of their transcutaneous passage driveline infections are a chronic problem of all current LVAD systems. We investigated as to whether driveline infections can be prevented by means of growth-factors applied to the driveline fleece. Methods: 6 patients were enrolled after HeartWare implantation at our hospital. Intraoperatively, the driveline and the transcutaneous tunnel were covered with Platelet Rich Fibrin®. All patients were observed over 30 days looking at early signs of a surgical site infection. Results: All patients were free from any infectious aspect after 30 days. The use of Plateled Rich Fibrin was easy and free of complications. All patients showed an expedited wound closure while driveline tunnel secretions ceased early as compared to previous HeartWare patients who had not received Platelated Rich Fibrin treatment. Conclusions: It can be speculated, that Platelet Rich Fibrin positively conditioned healing of the driveline fleece in the subcutaneous tunnel thereby preventing ascending infection. Plateled Rich Fibrin is easy to apply while adverse effects were not apparent. Our patients will be monitored closely in order to verify as to whether this initial treatment results in a reduction or absence of driveline infections in the chronic course.

Kuhnel R.-U.,Immanuel Klinikum Bernau | Mueller T.,Immanuel Klinikum Bernau | Spalding G.,Immanuel Klinikum Bernau | Monse W.,Immanuel Klinikum Bernau | Albes J.M.,Immanuel Klinikum Bernau
Kardiotechnik | Year: 2013

An increasing number of patients is submitted to cardiac surgery with an unclear P2Y12-inhibitor medication status requiring intra- or perioperative therapy to improve platelet function. The frequently used antiplatelet drugs Acetylsalicylic acid (Aspirin®), Clopidogrel (Plavix®), Prasug-rel (Efient®), Ticlopidin (Ticlid®), and Ti-cagrelor (Brilique®) with their different reaction- and half-lives represent a major problem for the evaluation of current platelet function in cardiac or peripheral vascular surgery. Thus far, in case of a suspicious impairment of platelet function platelet concentrates (PC) are ordered according to a standard operating procedure (SOP) and given on a clinical judgement resulting in additional risk for the patient and increased costs. The point of care testing (POCT) system Verify Now® allows a quantitative assessment of platelet activity in only a few minutes so that the degree of actual inhibition can be evaluated and an individual treatment necessity for platelet substitution can be derived. Patients from the department of cardiac surgery, intensive care medicine, and cardiology of the Immanuel Klinikum Bemau with P2Y12-inhibitor medication or suspicious thereof, for whom intra- or perioperative therapy with desmopressin (Minirin®) and platelet concentrates was deemed necessary, were investigated. P2Y12-reaction units (PRU-values) were quantitatively measured by means of Verify Now yielding a percentage of actual platelet inhibition. During the entire observation period in which VerifyNow was utilized application of PC could be avoided in 60 % of the patients, thereby preventing a superfluous therapy and assuming a reduction of thromboembolic complications. The measurement results correlated with the intraoperatively observed clinical coagulation state. The results allowed an optimized therapy for patients with an unclear status regarding their actual platelet aggregation. The P2Y12-reaction units (PRU-value) measured by means of VerifyNow and the thus observed percentage of platelet aggregation inhibition allowed an improved judgement of the individual bleeding risk. Furthermore, the cost saving potential of platelet concentrates economically justifies the targeted assessment of PRU-values.

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