Limiting Pericardial Adhesions after Coronary Artery Bypass: Experimental Study

Abstract

Retrosternal pericardial adhesion formation constitutes a major hazard during re-do coronary artery surgery. To determine whether an onlay parietal pleural flap over the internal thoracic artery bed would reduce pericardial adhesions after coronary artery grafting, 16 sheep underwent a median sternotomy and both internal thoracic arteries were harvested. On the randomly selected study side, a dissected pleural flap was used to cover the internal thoracic artery bed, the opposite side was left uncovered as a control. Half of the sheep were sacrificed at a median of 102 days (range, 93-109 days), the remainder at a median of 176 days (range, 165-183 days). Two independent observers blinded to the initial operation scored the degree of postoperative adhesions. There was a significant decrease in adhesion formation on the study side covered by the mobilized pleural flap, compared to the control side. There were no increases in pulmonary morbidity or sternotomy wound problems from raising the lateral pleural flap. This simple technique appears to be an effective method of preventing adhesion formation following coronary artery bypass grafting utilizing the internal thoracic artery.

TORACOSCOPIA NO DIAGNÓSTICO E NA LIBERAÇÃO DE ADERÊNCIAS PÓS-TORACOTOMIA E PÓS-CTVA (Cirurgia Torácica Vídeo-Assistida): ESTUDO EXPERIMENTAL EM CÃES

“…No entanto, as aderências são responsáveis por riscos associados a novas intervenções cirúrgicas, como, por exemplo, o acesso a órgãos indesejados, a invasão de órgãos e mesmo a perda do acesso. Saha et al (2004) afirmaram que a formação de aderências pericárdicas retroesternais se constitui no maior risco durante a reintervenção cirúrgica na artéria coronária. A cirurgia de invasão mínima tem despontado como alternativa a minimizar o dano tecidual e melhor recuperação pós-operatória (Maxfield, 2004;Walsh et al, 1999).…”

Site‐specific delivery of dexamethasone from biodegradable implants reduces formation of pericardial adhesions in rabbits

“…They often result in severe hemorrhage, as well as obscured anatomy and prolonged operation time, associated with significant mortality and morbidity rates. 1 An attempt was made to prevent such adhesions, using mechanical barriers such as postoperative native pericardial closure or biological and synthetic pericardial substitutes, [2][3][4][5][6][7][8] as well as systemically administered antiinflammatory agents. 9 Topical administration of fibrin sealant and fibrinolytic agents 10,11 has also been investigated.…”