A novel method to reduce pericardial adhesion: a combination technique with hyaluronic acid biocompatible membrane.
OBJECTIVE
This study was to evaluate the efficacy of the hyaluronic acid (HA) bioabsorbable membrane combined use with both expanded-polytetrafluoroethylene (ePTFE) and autologous pericardium for preventing postoperative pericardial adhesions.


METHODS
The HA bioresorbable surgical membrane (Seprafilm, Genzyme, Cambridge, Mass) was used with either ePTFE or autologous pericardium in an experimental pericardial adhesion model. Twenty-four beagle dogs were classified as follows; Group A (n = 6): ePTFE only, Group B (n = 6): Seprafilm + ePTFE, Group C (n = 6): autologous pericardium only, Group D (n = 6): Seprafilm + autologous pericardium. Pericardial adhesions were evaluated at necropsy at 4, 8, and 12 weeks. The tenacity of adhesion was graded by macroscopic examination, and the adhesion tissue thickness was analyzed microscopically with an image processing program. The regeneration of mesothelial cells on neo-tissue fibrils were immunohistochemically studied.


RESULTS
In groups B and D, the adhesions were significant lower compared with those of control groups in the tenacity (Group A vs B: 2.5 +/- 0.55 vs 1.5 +/- 0.55, P < 0.05; Group C vs D: 3.2 +/- 0.75 vs 0.33 +/- 0.52, P < 0.01) and the tissue thickness (Group A vs B: 30.4 +/- 12.9 vs 10.3 +/- 4.42, P < 0.01; Group C vs D: 22.6 +/- 11.5 vs 4.96 +/- 4.87, P < 0.01). Immunohistochemically, a single layer of mesothelial cells were regenerated on the surface of neo-tissue fibrils in HA treated groups.


CONCLUSIONS
The combined use of Seprafilm with either ePTFE or autologous pericardium effectively reduced the formation of pericardial adhesion.
Naito
Yuji
Y
Heart Institute of Japan, Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan. ujinaito@aol.com
Shin'oka
Toshiharu
T
Hibino
Narutoshi
N
Matsumura
Goki
G
Kurosawa
Hiromi
H
D000818:Animals; D001672:Biocompatible Materials / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures; D004195:Disease Models, Animal; D004285:Dogs; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D008567:Membranes, Artificial; D010496:Pericardium / Q000637:transplantation*; D011138:Polytetrafluoroethylene / Q000008:administration & dosage*; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*; D014182:Transplantation, Autologous
D001672:Biocompatible Materials; D008567:Membranes, Artificial; C118198:Seprafilm; D011138:Polytetrafluoroethylene; D006820:Hyaluronic Acid