Computed tomographic evaluation of retrosternal adhesions after pericardial substitution.
BACKGROUND
Reoperative median sternotomy can result in cardiac injury and serious bleeding, with the rate ranging from 2% to 6%. Closure of the native pericardium can maintain a preventing plane of cleavage. In patients in whom primary pericardial closure is not possible, several substitutes have been tried with variable results. We conducted a prospective study to evaluate the clinical feasibility of polytetrafluoroethylene and polyglycolic acid patches as pericardial substitutes, using computed tomography for imaging the postoperative state of the retrosternal space.


METHODS
The basic population comprised 540 patients who were scheduled for coronary artery bypass grafting, and 52 of them who met the research criteria were chosen for computed tomographic evaluation after 5 years after the primary operation.


RESULTS
As a substitute, polytetrafluoroethylene seemed to be less adhesive to the posterior surface of the sternum. Total adhesion scores were also statistically significant (p < 0.001) to the advantage of polytetrafluoroethylene over polyglycolic acid as a pericardial substitute.


CONCLUSIONS
Polytetrafluoroethylene membrane seems to be capable of minimizing retrosternal adhesion formation and thus it may protect the heart during subsequent reoperative sternotomy.
Lahtinen
J
J
Department of Surgery, Oulu University Hospital, University of Oulu, Finland.
Satta
J
J
Lähde
S
S
Suramo
I
I
Nissinen
J
J
Pokela
R
R
Juvonen
T
T
D001026:Coronary Artery Bypass / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery; D011100:Polyglycolic Acid; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D019736:Prostheses and Implants; D012086:Reoperation; D013249:Sternum / Q000601:surgery; D013526:Surgical Mesh; D000267:Tissue Adhesions / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
D011100:Polyglycolic Acid; D011138:Polytetrafluoroethylene