title: Repeat sternotomy after reconstruction of the pericardial sac with glutaraldehyde-preserved equine pericardium.
abstract: The risk of repeat sternotomy is higher than that of the initial sternotomy, especially if the pericardial sac was left open at the first intervention. In 200 consecutive patients with a pericardial defect after open heart operations, the pericardium was closed with a glutaraldehyde-preserved equine pericardial patch. Precardiac adhesions at reoperation were assessed in four groups of patients on a scale of 6, ranging from 0 (no adhesions) to 5 (calcified or ossified adhesions). Group I comprised 13 patients in whom the pericardium was left open at the first operation and an equine pericardial patch was implanted at reoperation. Group Ia included the first five Group I patients who underwent reoperation less than 1 year (early reoperation) after the initial procedure. Group Ib included the other eight patients of Group I, who underwent reoperation more than 1 year (late reoperation) after the first procedure. Group II comprised nine patients who were reoperated on after reconstruction of the pericardial sac with a glutaraldehyde-preserved equine pericardial patch. After a mean follow-up of 20.2 months, the incidence of patch-related complications was 1%. Statistical analysis shows less severe adhesions on reoperation in Group II patients (pericardial defect patched) than in Group I patients (pericardial defect left open): mean grade of adhesions 1.6 +/- 0.9 (Group II) versus 3.2 +/- 0.6 (Group I), p less than 0.001. Precardial adhesions with the pericardium left open were similar in patients having early and late reoperations: mean grade of adhesions 3.0 +/- 0.7 (Group Ia) versus 3.4 +/- 0.5 (Group Ib), no significant difference. Therefore, the glutaraldehyde-preserved equine pericardial patch can be considered a suitable material for primary closure of the pericardial sac in patients with inadequate autologous pericardium.
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001705:Bioprosthesis / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005976:Glutaral; D006736:Horses; D006801:Humans; D007223:Infant; D008297:Male; D010496:Pericardium / Q000637:transplantation*; D012086:Reoperation; D013249:Sternum / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology; D014021:Tissue Preservation; D014183:Transplantation, Heterologous
chemical_list: D005976:Glutaral