Meta-analysis of the use of surgical sealants for suture-hole bleeding in arterial anastomoses

Rogers, Ailín C.; Turley, Luke; Cross, K.S.; McMonagle, Morgan

doi:10.1002/bjs.10308

Cited by 15 publications

(7 citation statements)

References 43 publications

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“…4,5 Why it is important to do this review The use of surgical sealants for arterial anastomoses has been reviewed; however, few reviews and no metaanalyses, have assessed fibrin and thrombin sealants specifically. 6,7 A qualitative review on fibrin sealants in vascular and cardiac surgery concluded that most studies on fibrin sealants in vascular and cardiac surgery showed a benefit on achieving homeostasis. 7 However, the individual study Results were not meta-analysed to allow effect estimation.…”

Section: Description Of the Interventionmentioning

confidence: 99%

“…6,7 A qualitative review on fibrin sealants in vascular and cardiac surgery concluded that most studies on fibrin sealants in vascular and cardiac surgery showed a benefit on achieving homeostasis. 7 However, the individual study Results were not meta-analysed to allow effect estimation. In addition, since its publication important studies have been produced that warrant inclusion.…”

Section: Description Of the Interventionmentioning

confidence: 99%

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Fibrin and Thrombin Sealants in Vascular and Cardiac Surgery: A Systematic Review and Meta-analysis

Daud

Kaur

McClure

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS There have been few reviews and no meta-analyses assessing the effectiveness of fibrin and thrombin sealants in vascular and cardiac surgery. A qualitative review of fibrin sealants in vascular and cardiac surgery concluded that most studies on fibrin sealants in vascular and cardiac surgery showed a benefit on achieving homeostasis, yet individual study Results were not meta-analysed to allow effect estimation. There are still concerns regarding the adverse events associated with antigenicity of bovine thrombin or aprotinin used in the majority of commercially available fibrin sealants and the thrombogenicity associated with sealant use. This review explores the efficacy, as well as adverse effects, associated with newer and pre-existing fibrin sealants.Objective: In vascular and cardiac surgery, the ability to maintain haemostasis and seal haemorrhagic tissues is key. Fibrin and thrombin based sealants were introduced as a means to prevent or halt bleeding during surgery. Whether fibrin and thrombin sealants affect surgical outcomes is poorly established. A systematic review and meta-analysis was performed to examine the impact of fibrin or thrombin sealants on patient outcomes in vascular and cardiac surgery. Data sources: Cochrane CENTRAL, Embase, and MEDLINE, as well as trial registries, conference abstracts, and reference lists of included articles were searched from inception to December 2019. Review methods: Studies comparing the use of fibrin or thrombin sealant with either an active (other haemostatic methods) or standard surgical haemostatic control in vascular and cardiac surgery were searched for. The Cochrane risk of bias tool and the ROBINS-I tool (Risk Of Bias In Non-randomised Studies e of Interventions) were used to assess the risk of bias of the included randomised and non-randomised studies; quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Two reviewers screened studies, assessed risk of bias, and extracted data independently and in duplicate. Data from included trials were pooled using a random effects model. Results: Twenty-one studies (n ¼ 7 622 patients) were included: 13 randomised controlled trials (RCTs), five retrospective, and three prospective cohort studies. Meta-analysis of the RCTs showed a statistically significant decrease in the volume of blood lost (mean difference 120.7 mL, in favour of sealant use [95% confidence interval {CI} À150.6 e À90.7; p < .001], moderate quality). Time to haemostasis was also shown to be reduced in patients receiving sealant (mean difference À2.5 minutes [95% CI e4.0 e À1.1; p < .001], low quality). Post-operative blood transfusions, re-operation due to bleeding, and 30 day mortality were not significantly different for either RCTs or observational data. Conclusion:The use of fibrin and thrombin sealants confers a statistically significant but clinically small reduction in blood loss and time to haemostasis; it does not reduce blood transfusion. These Res...

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Section: Description Of the Interventionmentioning

confidence: 99%

Section: Description Of the Interventionmentioning

confidence: 99%

Fibrin and Thrombin Sealants in Vascular and Cardiac Surgery: A Systematic Review and Meta-analysis

Daud

Kaur

McClure

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…Thus, hemostatic agents can be effective here as well. Fibrin glues and other surgical sealants have shown significantly decreased bleeding time in vascular anastomoses compared to manual compression alone [45,46]. Given this favorable data, it would be worthy of consideration to use these products for anastomoses with the goal of decreasing blood loss and operative time.…”

Section: Graft Bleeding (After Venous Resection/reconstruction)mentioning

confidence: 99%

Use of Biosurgicals in Hepatobiliary Surgery

Clanton¹,

Seal²

2019

Contemporary Applications of Biologic Hemostatic Agents Across Surgical Specialties - Volume 2 [Working Title]

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Through innovative technologies and refinement of surgical technique over the last several decades, hepatopancreatobiliary (HPB) surgeries have become increasingly common for both malignant and benign disease. HBP surgeries often present unique challenges even for the experienced surgeon, whether due to liver cirrhosis causing portal hypertension and impairment of natural clotting abilities or a large pancreatic mass invading into nearby mesenteric vessels. Major intraoperative blood loss is still a concern and is known to be a major factor influencing morbidity and mortality. Biosurgicals are increasingly used as adjuncts to reduce blood loss during these complex procedures, but also to even reduce rates of biliary and pancreatic leaks and fistulas postoperatively. While initially biosurgical agents offered some hope to make the difference in completing a safe and effective operation, more recent and rigorous studies have failed to demonstrate reproducible benefits. This chapter reviews the use of hemostatic agents in the setting of hepatobiliary and pancreatic surgery, including for the maintenance of hemostasis and the prevention of biliary and pancreatic leaks. We also discuss what factors should be considered when choosing the correct agents for different clinical scenarios during HPB surgery.

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“…The adjunctive use of a surgical sealant to reinforce suture lines during surgery has been shown to significantly improve haemostasis, reduce blood loss and transfusion requirements, and shorten the duration of surgery. 1 This is not only advantageous for the patient, but has the potential to provide significant economic benefits to the healthcare system. 2,3 An ideal sealant for use on vascular tissue should combine elasticity and flexibility with strong tissue adhesion and favourable biocompatibility.…”

Section: Introductionmentioning

confidence: 99%

Tissue reactions to polyethylene glycol and glutaraldehyde-based surgical sealants in a rabbit aorta model

et al. 2020

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Surgical sealants help achieve rapid haemostasis when applied as an adjunct to sutures in vascular surgery, but their use can lead to various side effects. This study compared the local inflammatory reaction to commercially available BioGlue and Coseal sealants in a rabbit aorta suture hole model. Twenty male New Zealand white rabbits were randomised to testing with either BioGlue or Coseal. Two weeks after sealant application to suture holes, sections of the aorta at the puncture site, and surrounding tissue, were processed for histopathological analysis. Inflammation was graded from 0 to 3 according to tissue alteration and presence of inflammatory cells. Material stiffness was measured in vitro using compression testing. From examination of the inflammatory response to the sealants, a less severe histopathological assessment score was assigned to the Coseal compared to the BioGlue group (mean AE SD: 1.56 AE 0.53 vs 2.67 AE 0.50; p ¼ 0.002). While both materials triggered a typical foreign body reaction characterised by granulomatous inflammation, BioGlue additionally provoked eosinophilic cell infiltration. Lymphocytes, plasma cells and B cells were also more prevalent in the BioGlue compared to the Coseal specimens. Coseal residue was either absent or visible in only small quantities, while significant BioGlue deposits remained in the tissue 2 weeks after application. Coseal was much more elastic than BioGlue, with a compressive modulus an order of magnitude lower (mean AE SD: 91 AE 41 vs 1833 AE 297 kPa). Compared to BioGlue, Coseal elicited a less pronounced inflammatory response in the aortic and periaortic tissue in this model, and demonstrated greater elasticity.

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Meta-analysis of the use of surgical sealants for suture-hole bleeding in arterial anastomoses

Abstract: Surgical sealants appear to reduce suture-hole bleeding significantly in vascular prosthetic graft anastomoses compared with standard haemostatic measures.

Cited by 15 publications

References 43 publications

Fibrin and Thrombin Sealants in Vascular and Cardiac Surgery: A Systematic Review and Meta-analysis

Fibrin and Thrombin Sealants in Vascular and Cardiac Surgery: A Systematic Review and Meta-analysis

Use of Biosurgicals in Hepatobiliary Surgery

Tissue reactions to polyethylene glycol and glutaraldehyde-based surgical sealants in a rabbit aorta model

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