Adhesion barrier reduces postoperative adhesions after cardiac surgery.
Reoperation in cardiac surgery is associated with increased risk due to surgical adhesions. Application of a bioresorbable material could theoretically reduce adhesions and allow later development of a free dissection plane for cardiac reoperation. Twenty-one patients in whom a bioresorbable hyaluronic acid-carboxymethylcellulose adhesion barrier had been applied in a preceding surgery underwent reoperations, while 23 patients underwent reoperations during the same period without a prior adhesion barrier. Blinded observers graded the tenacity of the adhesions from surgical video recordings of the reoperations. No excessive bleeding requiring wound reexploration, mediastinal infection, or other complication attributable to the adhesion barrier occurred. Multiple regression analysis showed that shorter duration of the preceding surgery, non-use of cardiopulmonary bypass in the preceding surgery, and use of the adhesion barrier were significantly associated with less tenacious surgical adhesions. The use of a bioresorbable material in cardiac surgery reduced postoperative adhesions, facilitated reoperation, and did not promote complications. The use of adhesion barrier is recommended in planned staged procedures and those in which future reoperation is likely.
Division of Cardiovascular Surgery, National Medical Center for Children and Mothers, Tokyo, Japan. yukihirokaneko@hotmail.com
Yukihiro
Y
Kaneko
Yasutaka
Y
Hirata
Ikuya
I
Achiwa
Hiroyuki
H
Morishita
Hajime
H
Soto
Jotaro
J
Kobayahsi
D001672:Biocompatible Materials; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D006820:Hyaluronic Acid / Q000737:chemistry*; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008567:Membranes, Artificial; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects*; D013896:Thoracic Diseases / Q000209:etiology / Q000517:prevention & control*; D000267:Tissue Adhesions; D016896:Treatment Outcome; D014741:Video Recording
D001672:Biocompatible Materials; D008567:Membranes, Artificial; C118198:Seprafilm; D006820:Hyaluronic Acid