Prevention of postoperative pericardial adhesions using thermal sterile carboxymethyl chitosan.
OBJECTIVE
The aim of this study is to evaluate CMC physical-chemical alterations after thermal sterilization and its efficacy in preventing poststernotomy pericardial adhesions.


METHODS
After autoclaving thermal sterilization, thermal sterile Carboxymethyl Chitosan (CMCts) was submitted to physical-chemical analysis. Twelve animals were divided into two groups and underwent pericardiotomy and adhesion induction protocol. Afterward, topic CMCts or saline solution was administered. After 8 weeks, a sternotomy was performed for adhesion score macroscopic evaluation, dissection time and the amount of recalcitrant dissection, and microscopic evaluation.


RESULTS
Physical-chemical analysis showed no difference between CMC and CMCts. A macroscopic analysis showed that the intensity of adhesions was significantly lower in the CMCts group (P=0.007). Dissection time and use of recalcitrant dissection also decreased significantly (P=0.007, P=0.008; respectively). Microscopic results indicated a significant reduction in the epicardium collagen area and in the total epicardium area (P=0.05) and (P=0.03).


CONCLUSIONS
The sterilization method did not change Carboxymethyl Chitosan physical-chemical properties. Using barrier biopolymer, such as CMCts, can decrease the intensity of pericardium postoperative adhesions, reducing sternotomy complications in cardiovascular reoperations.
Daroz
Luiz Renato Dias
LR
Heart Institute of the Faculty of Medicine of the University of São Paulo, Márcio Cunha Hospital, São Francisco Xavier Foundation/USIMINAS. lrenatod@ig.com.br
Lopes
Jackson Brandão
JB
Dallan
Luis Alberto Oliveira
LA
Campana-Filho
Sérgio Paulo
SP
Moreira
Luiz Felipe Pinho
LF
Stolf
Noedir Antônio Groppo
NA
D000818:Animals; D001672:Biocompatible Materials / Q000737:chemistry* / Q000494:pharmacology; D048271:Chitosan / Q000031:analogs & derivatives* / Q000737:chemistry / Q000494:pharmacology; D003094:Collagen / Q000378:metabolism; D006331:Heart Diseases / Q000517:prevention & control*; D023421:Models, Animal; D010496:Pericardium / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D011897:Random Allocation; D012086:Reoperation; D013242:Sterilization / Q000379:methods*; D013249:Sternum / Q000601:surgery; D013552:Swine; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control
D001672:Biocompatible Materials; C514968:carboxymethyl-chitosan; D003094:Collagen; D048271:Chitosan