title: Prevention of postcardiopulmonary bypass pericardial adhesions by a new resorbable collagen membrane.
abstract: Reduction in mediastinal adhesions is an issue in cardiac surgery. To evaluate a porcine-bioengineered collagen membrane (Cova™ CARD) intended to promote tissue regeneration, 18 sheep underwent a sternotomy and a 30 min period of cardiopulmonary bypass. They were divided into three equal groups: pericardium left open, placement of an e-polytetrafluoroethylene membrane (Preclude(®)) taken as a non-absorbable substitute comparator and placement of the absorbable Cova™ CARD membrane. Four months thereafter, the study animals underwent repeat sternotomy and were macroscopically assessed for the degree of material resorption and the intensity of adhesions. Explanted hearts were evaluated blindly for the magnitude of the inflammatory response, fibrosis and epicardial re-mesothelialization. The bioengineered membrane was absorbed by 4 months and replaced by a loosely adherent tissue leading to the best adhesion score. There was no inflammatory reaction (except for a minimal one in an animal). Fibrosis was minimal (P = 0.041 vs Preclude(®)). The highest degree of epicardial re-mesothelialization, albeit limited, was achieved by the bioengineered group in which five of six sheep demonstrated a new lining of mesothelial cells in contrast to two animals in each of the other groups. This collagen membrane might thus represent an attractive pericardial substitute for preventing post-operative adhesions.
authors.affiliation: Department of Cardiovascular Surgery, Assistance Publique - Hôpitaux de Paris, Hospital European Georges Pompidou, Paris, France. alain.bel@egp.aphp.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Bel
authors.forename: Massimo
authors.initials: M
authors.lastname: Ricci
authors.forename: Julie
authors.initials: J
authors.lastname: Piquet
authors.forename: Patrick
authors.initials: P
authors.lastname: Bruneval
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Perier
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 / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D024042:Collagen Type I / Q000009:adverse effects; D005355:Fibrosis; D005549:Foreign-Body Reaction / Q000209:etiology / Q000473:pathology; D006331:Heart Diseases / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D008422:Materials Testing; D008567:Membranes, Artificial; D023421:Models, Animal; D010496:Pericardium / Q000473:pathology*; D011138:Polytetrafluoroethylene; D012038:Regeneration; D012756:Sheep; D056346:Sternotomy; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*; D014945:Wound Healing
chemical_list: D001672:Biocompatible Materials; D024042:Collagen Type I; D008567:Membranes, Artificial; D011138:Polytetrafluoroethylene