Effect of melatonin in the prevention of postoperative pericardial adhesion formation

Abstract

To evaluate the efficacy of melatonin in preventing postoperative pericardial adhesions, 12 single breed dogs were randomized equally into experimental (melatonin) and control groups. After ketamine anesthesia, a vertical midsternal incision was done and the parietal pericardium of the inferior site of the heart was opened vertically. To promote adhesion formation, abrasions were created on both parietal and visceral pericardial surfaces in an area of 2 cm2 with two vertically reciprocal movements of dry gauze. In the melatonin group, 5% ethanol plus 10 mg/kg melatonin in 10 ml NaCl and, in control group, 10 ml NaCl dilution vehicle containing 5% ethanol was instilled intra-pericardium on to the abrasion sites. After a 6-week recovery period, the animals were evaluated for grading of adhesion formation by an examiner blinded to the groups. The extent of adhesions was graded from 0 (no adhesion) to 3 (total involvement of the traumatized area). The results showed that adhesion scores were significantly lower in melatonin group (1.00+/-0.63) compared with controls (2.66+/-0.51); P=0.001. We conclude that melatonin administration effectively reduced postoperative pericardial adhesions in dogs. The use of melatonin in the prevention of pericardial adhesion formation in human subjects warrants further investigations.

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

“…The barriers do not target the underlying pathological processes. Fibrinolytics [16], antioxidants [17] and corticosteroids [18] have been tested with some effect. These have not, however, been used widely clinically, only in part as the liquid solutions of pharmacological drugs, and have only had a transient effect as they can be drained by chest tubes.…”

Assessment of the efficacy of Ankaferd blood stopper on the prevention of postoperative pericardial adhesions : cardiovascular topic

“…These adhesions are an important cause of morbidity and mortality in cardiac surgery 16. Pericardial adhesions may attach the heart to the undersurface of the sternum and neighboring structures, compromise right ventricular contraction, and restrict left ventricular diastolic filling.…”

“…This leads to the formation of serosanguineous exudate, which in turn initiates adhesion formation 16. Fibrin provides a framework for fibroblast proliferation, the synthesis of collagen and adhesion formation 18…”

“…Evidence has shown that ROS scavengers could reduce adhesion formation in animal models 16,21. Subsequently, if these initial adhesions are not lysed, they are organised into fibrous adhesions by activated fibroblasts.…”

“…Subsequently, if these initial adhesions are not lysed, they are organised into fibrous adhesions by activated fibroblasts. However, in a state of imbalance between fibrin deposition and dissolution, deposited fibrin may persist and fibrinous adhesions may develop 16,21…”