Prevention of postoperative pericardial adhesions with TachoSil.
BACKGROUND
The prevention of the pericardial adhesions largely accountable for the technical difficulty and risk of injury inherent to resternotomy continues to gain in importance with the increasing frequency of reoperations. The hemostatic sponge TachoSil (Nycomed Austria GmbH, Linz, Austria), has shown promising results in adhesion prevention in several regions of the body. This study was designed to evaluate its effectiveness in the prevention of pericardial adhesions in comparison with the Gore-Tex (W. L. Gore and Assoc, Flagstaff, AZ) surgical membrane and a control.


METHODS
Twenty-four rabbits were distributed into 3 groups: TachoSil, Gore-Tex, or no barrier agent (control). After median sternotomy and pericardiotomy, the cardial surface was exposed to the aggravating effects of room air, irrigation, and gauze abrasion for one hour. A pericardial defect was created and repaired with one of the barrier agents, or left uncovered (control). Resternotomy was performed after 6 months for the evaluation of adhesion formation.


RESULTS
Significantly fewer macroscopic adhesions were observed with TachoSil than Gore-Tex in all regions (p < 0.05) excluding the coronary arteries, where the difference in favor of TachoSil did not achieve significance (0.05< p-value <0.10). TachoSil also demonstrated significantly fewer retrosternal adhesions than the control, as well as a universal non-significant trend of fewer adhesions in all regions. The limited lesions present in the TachoSil group were filmy in nature and removed with blunt dissection relatively easily. No significant differences were found between Gore-Tex and the control. Microscopically, the least pronounced fibrosis formation and inflammatory reaction was detected with TachoSil.


CONCLUSIONS
TachoSil is effective in the prevention of pericardial adhesions.
Department of Pediatric Cardiac Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany. tarah.kuschel@erlanger.org
Tarah J
TJ
Kuschel
Anna
A
Gruszka
Benita
B
Hermanns-Sachweh
Jaouad
J
Elyakoubi
Joerg S
JS
Sachweh
Jaime F
JF
Vázquez-Jiménez
Heike
H
Schnoering
D000818:Animals; D004195:Disease Models, Animal; D004338:Drug Combinations; D005260:Female; D005340:Fibrinogen; D006331:Heart Diseases / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D010496:Pericardium / Q000473:pathology*; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D011184:Postoperative Period; D011817:Rabbits; D015503:Surgical Sponges; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D013917:Thrombin; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*
D004338:Drug Combinations; C518955:TachoSil; D005340:Fibrinogen; D013917:Thrombin