A novel adhesion barrier facilitates reoperations in complex congenital cardiac surgery.
OBJECTIVE
Reoperations are associated with an increased surgical risk due to adhesions. We prospectively evaluated a bioresorbable membrane after surgery for congenital heart defects over a 3.5-year period.


METHODS
The surgical membrane (CV Seprafilm, Genzyme, Cambridge, Mass) was applied in 350 of 1024 patients; 30 of them underwent reoperation and were evaluated in comparison to 10 random reoperated patients. Adhesions were evaluated using a subjective scoring system [1 (lowest tenacity) to 5 (highest tenacity)] and extent in percent at different regions of the heart.


RESULTS
Patients were operated for atrioventricular septal defect (69), tetralogy of Fallot (65), functional single ventricle (75), valve surgery (48), ventricular septal defect (20), subaortic stenosis (17), hypoplastic left heart syndrome (17), and other diagnoses (39). Application of the surgical membrane was safe in all patients, without any infections. At reoperation patients received Glenn (14), total cavopulmonary connection (6), and others (10). Overall mortality was 2/350 (0.57%). There was a remarkable reduction in tenacity score (3.3 vs 4.3) and in the extent of adhesions (77.7% vs 86%). Duration of reoperation was significantly reduced.


CONCLUSIONS
A bioresorbable surgical membrane leads to a significant reduction in the tenacity and amount of adhesions. It is recommended for general use whenever repeat operation is anticipated in congenital as well as in adult cardiac surgery.
Walther
Thomas
T
Heartcenter, Department of Cardiac Surgery, Leipzig, Germany. walt@medizin.uni-leipzig.de <walt@medizin.uni-leipzig.de>
Rastan
Ardawan
A
Dähnert
Ingo
I
Falk
Volkmar
V
Jacobs
Stefan
S
Mohr
Friedrich W
FW
Kostelka
Martin
M
D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000401:mortality / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000601:surgery; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D016019:Survival Analysis; D013771:Tetralogy of Fallot / Q000401:mortality / Q000601:surgery; D000267:Tissue Adhesions; D016896:Treatment Outcome