Adhesion barrier reduces postoperative adhesions after cardiac surgery

Abstract

Reoperation in cardiac surgery is associated with increased risk due to surgical adhesions. Application of a bioresorbable material could theoretically reduce adhesions and allow later development of a free dissection plane for cardiac reoperation. Twenty-one patients in whom a bioresorbable hyaluronic acid-carboxymethylcellulose adhesion barrier had been applied in a preceding surgery underwent reoperations, while 23 patients underwent reoperations during the same period without a prior adhesion barrier. Blinded observers graded the tenacity of the adhesions from surgical video recordings of the reoperations. No excessive bleeding requiring wound reexploration, mediastinal infection, or other complication attributable to the adhesion barrier occurred. Multiple regression analysis showed that shorter duration of the preceding surgery, non-use of cardiopulmonary bypass in the preceding surgery, and use of the adhesion barrier were significantly associated with less tenacious surgical adhesions. The use of a bioresorbable material in cardiac surgery reduced postoperative adhesions, facilitated reoperation, and did not promote complications. The use of adhesion barrier is recommended in planned staged procedures and those in which future reoperation is likely.

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

“…The study demonstrated a reduction in tenacity score, the extent of the adhesions and duration of the operation. More recently, Kaneko et al [26] demonstrated similar results. However, in the aforementioned study, some of the patients in hyaluronic acid membrane group had the pericardium left open, some closed and some augmented with ePTFE membrane.…”

Is Seprafilm valuable in infant cardiac redo procedures?

“…A recent report by Kaneko et al compared 22 patients who underwent cardiac reoperation after Seprafilm® application during the previous surgery with 23 patients reoperated without application of an adhesion barrier. The surgical adhesions were graded prospectively from video recordings during reoperation: they were less tenacious if Seprafilm® had been used [ 8 ].…”

Battling adhesions: from understanding to prevention

“…This solid adhesion barrier limited the formation of cardiac retrosternal adhesions in pigs [ 82 ]. Seprafilm® has also been proven to be safe in cardiac surgery and to reduce the formation of adhesions [ 83 , 84 ]. Another barrier that consists of a collagen membrane is COVA™ CARD.…”