A Biodegradable Patch used as a Pericardial Substitute after Cardiac Surgery: 6- and 24-Month Evaluation with CT

Abstract

Biodegradable patches made of polyhydroxybutyrate (PHB) were recently shown to limit postoperative pericardial adhesions when inserted into the pericardium in sheep. The present study was carried out to evaluate the presence of post-operative retrosternal adhesions after cardiac surgery in patients operated on with the PHB patch compared with those operated on without the insertion of such a patch. 50 patients admitted for CABG and/or valvular replacement were randomised to treatment either with pericardial closure with a patch or with the pericardium left open. In 39 of these (19 with and 20 without a PHB patch) computerised tomography was carried out six and twenty-four months postoperatively. Computerised tomography indicated a lower incidence (p < 0.05) of postoperative adhesions between the patch and the cardiac surface in the patch group, compared with the corresponding area in the non-patch group. A reduction of patch size in 27% (p = 0.003) was also seen.

Effects of Angiotensin Type-I Receptor Blockade on Pericardial Fibrosis

“…Therefore, strategies to prevent or reduce pericardial fibrosis are warranted. However, the majority of past studies which have attempted to reduce the clinical impact of pericardial fibrosis have been focused upon the direct application of biodegradable lubricants or patches on the pericardial surface [8,9]. The present study examined whether selective interruption of Ang AT 1 receptor activation during a 28-day postoperative period would influence pericardial fibrosis following incision and closure of the pericardium (pericardiotomy) in pigs.…”

“…Pericardial fibrosis encountered at reoperation prevents easy access to the myocardium and results in difficult and blind dissections which can cause an increase in the duration of the procedure [1,7,9]. In the postoperative period, pericardial fibrosis can adversely affect ventricular filling as well as patency of the newly placed vascular conduits [7].…”

“…An important contributory factor for the increased complications with cardiac reoperations is the fibrosis which develops secondarily from the initial entry into the pericardium [1][2][3][4][5][6]. The fibrous adhesions begin to form immediately following the surgical procedure and consist of collagen and other extracellular proteins [7][8][9]. It has been demonstrated in a number of cell systems that enhanced collagen synthesis can occur due to increased production of angiotensin II (Ang-II) and subsequent activation of the Ang AT 1 receptor [10,11].…”

ElastoPHB® Membrane Systems with Immobilized Bone Marrow Stromal Cells Optimize Conditions for Regeneration of Damaged Tissue

“…Membranes based on polymers and copolymers of chemical (lactic and glycolic acid copolymers) and natural (including bacterial) origin (chytosan, hyaluronic acid esters, alginate, collagen, silk fibroins, polyhydroxybutyrate (PHB) and its copolymers) were studied as biomaterials for organization of cell growth and differentiation to be used for wound and burn healing, for preventing the formation of postoperative adhesions, for temporary replacement of damaged or lost tissues (e.g., bone tissue) [13,[18][19][20]24].…”

Neuronal survival using a resorbable synthetic conduit as an alternative to primary nerve repair

“…17 The present material, produced and provided by Astra Tech (Mölndal, Sweden), is a nonwoven sheet with unidirectional fiber orientation that has previously been clinically studied as a repairing material in cardiovascular surgery. 19,20,22 By examining the neuronal loss within the DRG of a purely sensory nerve, this study aimed to compare nerve repair using PHB conduits in the uncomplicated situation to immediate microsurgical suturing.…”