A new absorbable collagen membrane to reduce adhesions in cardiac surgery☆

Abstract

Reduction of sternal adhesions is still an issue in cardiac surgery. To evaluate a new fibrillar porcine collagen absorbable membrane (Cova CARD), 16 sheep underwent a sternotomy followed by scratching of surface of the heart. They were then divided into three groups: pericardium left opened (n=4), placement of Seprafilm), the reference absorbable substitute (hyaluronic acid and carboxymethylcellulose, n=6) or of Cova CARD membrane (n=6). Four months thereafter, the animals underwent repeat sternotomy and were macroscopically assessed for the degree of resorption of the material and the intensity of adhesions. Explanted hearts were blindly evaluated for the magnitude of the inflammatory response and fibrosis. The Cova CARD membrane was almost totally absorbed by four months and replaced by a loosely adherent tissue. There was no inflammatory reaction and both the extent and density of fibrosis were minimal. The composite score (median [min;max]) integrating tightness of adhesions and histological findings of inflammation and fibrosis was two-fold lower in the Cova CARD than in the Seprafilm) group (2.0 [0;3.5] vs. 5.5 [3;7], P=0.01 by Wilcoxon test). The Cova CARD membrane might represent an attractive pericardial substitute for preventing postoperative adhesions in cardiac surgery.

Combined use of barrier methods to prevent pericardial adhesions: Is it always better?

“…Subsequently, normal pericardial mesothelial cell growth is observed on the surfaces free of adhesions. [1] Therefore, the basic methods studied to prevent adhesions include fibrinolytic agents, [2] anti-inflammatory agents, [3,4] permanent physical barriers which involve pericardial closure either directly or using an ePTFE membrane as a substitute [5,6] and resorbable barriers to prevent early fibrin deposition [7][8][9][10][11][12][13][14][15][16][17] N-acetyl cysteine have been also shown to reduce adhesions probably through fibroblast inhibition, since it is in liquid form the ideal method of application is still undetermined. [21] The closure of pericardium has been used as a barrier method to decrease the adhesions.…”

“…Materials used as a resorbable barrier involve polylactic acid, [7,8] sprayable polyethylene glycol, [9] porcine collagen membrane, [10] hyaluronic acid membrane, [11,12] hyaluronic acid/carboxymethyl cellulose solution, [13] and polyethylene glycol/ polylactic acid membrane. [14,15] Among these materials, polyethylene glycol/polylactic acid membrane [16] and hyaluronic acid membrane [17] have been shown to decrease pericardial adhesions when used in combination with ePTFE membrane, compared to the isolated use of ePTFE membrane.…”

No Effect of Rapamycin on Cardiac Adhesion Formation: A Drug-Loaded Bioresorbable Polylactone Patch in a Porcine Cardiac Surgical Model

“…Bel et al [5] tested the CovaCard ECM membrane in subjects compared to a control group and the Seprafilm (Genzyme, Cambridge, Mass., USA) hyaluronic acid membrane in a large animal model with a 4-month observation period. They found no effect of Seprafilm on cardiac adhesions; however, they found significantly weaker adhesions with CovaCard, as well as a lesser degree of inflammation.…”

“…Commercially available examples include the pericardial repair patches CovaCARD (collagen patch; Biom'Up, Paris, France) [5] and Cormatrix (porcine extracellular matrix, ECM; Roswell, Ga., USA) [6], both of which have been used in thoracic surgery along with GoreTex barriers.…”

Could the Material Wrapped Around the Heart Prevent Adhesion? A Case Report

“…These cells prevent adhesion by synthesizing growth factors, lubricants and extracellular matrix proteins and secreting fibrin scavenging factors [3]. Some local drugs or biologicals can prevent adhesion [4].…”