The use of an artificial pericardium with a total artificial heart.
Postoperative adhesions following open heart surgery enhance the risks and increase the time of subsequent reoperation. When possible, primary closure of the natural pericardium is recommended, particularly in those cases that are more likely to be reoperated upon. The use of a total artificial heart (TAH) as a bridge to transplantation makes reoperation mandatory. If the pleura is left open to accommodate the ventricles, the risk of adhesion is considerable. To address this question, gluteraldehyde-fixed pericardial allografts were evaluated in calves undergoing TAH replacement. Eight animals were implanted with 3 different types of TAHs and survived from 12 to 108 days (mean 52.8 +/- 14.5). The pericardial substitute was wrapped around the TAH and the vascular grafts and cuffs. Two different surgical techniques were evaluated. At the time of autopsy, the presence of adhesions and gross epicardial reaction was macroscopically characterized and classified according to a standardized scale. Bacterial cultures were taken and tissue submitted for histology. The animals implanted with pericardial allografts for periods greater than 3 weeks were observed to have greater adhesions than those implanted for periods less than 3 weeks (p = 0.006). Pericardial cultures were negative in all cases and neovascularization and fibroplasia of the underlying tissues occurred in all cases. Leukocyte infiltration was minimal in the shorter term implant animals. Degeneration of a portion of the pericardium occurred in only 2 cases after 90 days. Minor calcification of the artificial pericardium was noted, but only in the longer term implant animals. The artificial pericardium reduced adhesion, thus facilitating reoperation in implants lasting up to a month.(ABSTRACT TRUNCATED AT 250 WORDS)
De Paulis
R
R
Institute for Biomedical Engineering, University of Utah, Salt Lake City.
Riebman
J B
JB
Deleuze
P
P
Mohammad
F S
FS
Burns
G L
GL
Morea
M
M
Olsen
D B
DB
D000818:Animals; D001705:Bioprosthesis; D002417:Cattle; D006085:Graft Survival; D006354:Heart, Artificial; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation; D013997:Time Factors; D000267:Tissue Adhesions / Q000517:prevention & control; D014184:Transplantation, Homologous