Autologous fibrin glue reinforced by platelets in surgery of ascending aorta. Clinical efficacy and economical benefit

Objectives: Fibrin sealents have become popular in improving perioperative hemostasis and reducing the need for allogeneic red cell transfusion. However, biological glues prepared from pooled human donor plasma have an inherent risk of transmission of blood-borne disease and are quite expensive to use. To overcome thes disadvantages a system for production of autologous fibrin sealant re-inforced by platelets has been developed. Its efficacy, safety andeconomic benefits has been evaluated in this prospective, randomized and partly blinded study.

Material and Methods: 20 consecutive patients undergoing replacement of the ascending aorta by the same surgical team had local application of either Tissucol™ (Group A) or Autologous fibrin glue (Group B) for hemostasis. Adverse effects, postoperative bleeding and economic benefit were evaluated.

Results: No adverse effect of either glue were recorded. The volume of produced autologous fibrin glue was 25 cc PRP. Platelet yield was 72%. Sex, age, Euroscore, associated diseases and concomitant additional surgical procedures, aortic cross-clamping and CPB-times revealed no group differences. Total blood loss and transfusion requirements did not reveal statistically significant group differences. The average cost for glue in Group A was 470±100 Euros, compared to 273 Euros in Group B, p=0,004, or96 Euros/cc (Group A) versus 11 Euros/cc (Group B).

Conclusions: Autologous fibrin glue re-inforced by autologous platelets can be safely produced in the operating room in large volumes, with an efficacy at least as good as when Tissucol™ was used but at a significantly lower cost.