Reduction of perioperative hemorrhage by anterior mediastinal spray application of fibrin glue during cardiac operations.
A variety of published techniques for the production of concentrated fibrinogen from units of screened single-donor human plasma have led to increasing clinical use of fibrin glue in the United States. We have adapted a method of applying this material with a disposable plastic sprayer. In 20 consecutively treated patients, fibrin glue was sprayed on the anterior mediastinum before closure of the median sternotomy incision. A control group of 20 patients undergoing the identical cardiac operations (13 coronary artery bypass grafting procedures [CABG], 4 valve replacements [including 1 reoperative procedure], and 3 combined valve replacements and CABG) by the same surgeon within a one-year period was chosen for comparison of chest tube outputs. Specifically, chest tube outputs were as follows for treated and untreated patients, respectively: at 12 hours, 461 +/- 40 ml (mean +/- 1 standard error of the mean versus 731 +/- 80 ml; at 24 hours, 714 +/- 73 ml versus 1,016 +/- 109 ml; and at 48 hours, 863 +/- 93 ml versus 1,187 +/- 137 ml. The differences between control and spray chest tube output are statistically significant by unpaired t test (p less than 0.05) at both 12 and 24 hours. Thus, this method can reduce perioperative hemorrhage from the anterior mediastinum after cardiac operations.
D000336:Aerosols; D007611:Aprotinin / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures; D004322:Drainage; D004338:Drug Combinations / Q000008:administration & dosage; D005176:Factor XIII / Q000008:administration & dosage*; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen / Q000008:administration & dosage*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007440:Intubation; D008482:Mediastinum; D011183:Postoperative Complications / Q000517:prevention & control; D013909:Thorax; D013917:Thrombin / Q000008:administration & dosage*; D014014:Tissue Adhesives / Q000008:administration & dosage*
D000336:Aerosols; D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D005340:Fibrinogen; D005176:Factor XIII; D007611:Aprotinin; D013917:Thrombin