title: A new absorbable collagen membrane to reduce adhesions in cardiac surgery.
abstract: Reduction of sternal adhesions is still an issue in cardiac surgery. To evaluate a new fibrillar porcine collagen absorbable membrane (Cova CARD), 16 sheep underwent a sternotomy followed by scratching of surface of the heart. They were then divided into three groups: pericardium left opened (n=4), placement of Seprafilm), the reference absorbable substitute (hyaluronic acid and carboxymethylcellulose, n=6) or of Cova CARD membrane (n=6). Four months thereafter, the animals underwent repeat sternotomy and were macroscopically assessed for the degree of resorption of the material and the intensity of adhesions. Explanted hearts were blindly evaluated for the magnitude of the inflammatory response and fibrosis. The Cova CARD membrane was almost totally absorbed by four months and replaced by a loosely adherent tissue. There was no inflammatory reaction and both the extent and density of fibrosis were minimal. The composite score (median [min;max]) integrating tightness of adhesions and histological findings of inflammation and fibrosis was two-fold lower in the Cova CARD than in the Seprafilm) group (2.0 [0;3.5] vs. 5.5 [3;7], P=0.01 by Wilcoxon test). The Cova CARD membrane might represent an attractive pericardial substitute for preventing postoperative adhesions in cardiac surgery.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiovascular Surgery, Ecole de Chirurgie, 75908 Paris, France. alain.bel@egp.aphp.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Bel
authors.forename: Levon
authors.initials: L
authors.lastname: Kachatryan
authors.forename: Patrick
authors.initials: P
authors.lastname: Bruneval
authors.forename: Séverine
authors.initials: S
authors.lastname: Peyrard
authors.forename: Christian
authors.initials: C
authors.lastname: Gagnieu
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Fabiani
authors.forename: Philippe
authors.initials: P
authors.lastname: Menasché
mesh_terms: D000818:Animals; D001672:Biocompatible Materials; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004195:Disease Models, Animal; D005355:Fibrosis; D006331:Heart Diseases / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D006820:Hyaluronic Acid; D010496:Pericardium / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012756:Sheep; D056346:Sternotomy / Q000009:adverse effects*; D013536:Suture Techniques; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control
chemical_list: D001672:Biocompatible Materials; C118198:Seprafilm; D006820:Hyaluronic Acid