title: In vitro comparison of two widely used surgical sealants for treating alveolar air leak.
abstract: BACKGROUND
  Controversies surrounding the efficacy of sealants against alveolar air leak (AAL) are abundant in the literature. We sought to test the widely used sealants, TachoSil (Takeda Pharmaceutical Company Limited, Osaka, Japan) and BioGlue (CryoLife Europa Ltd., Surrey, United Kingdom) in an in vitro model. Materials and
  
  
  METHODS
  After creation of a focal superficial defect (40 × 25 mm) in swine lungs (n=40), AAL was assessed with increasing inspired tidal volume (TVi). Upon sealant application in a randomized order, AAL was assessed in the same way until sealant burst.
  
  
  RESULTS
  At TVi =400, 500, 600, and 700 mL, BioGlue achieved sealing in 19, 19, 16, and 14 tests, while TachoSil sealed in 19, 14, 4, and no test, respectively. The maximally tolerated pressure of BioGlue was higher than TachoSil (40.3 ± 3.0 vs. 36.0 ± 4.9 cm H2O, p=0.003). Cohesive and adhesive failures were found in 10 and 1 tests of BioGlue, respectively, while all burst failures of TachoSil were adhesive. Concerning elasticity, TachoSil allowed more expansion of the covered defect than BioGlue (6.3 ± 3.9 vs. 1.4 ± 1.0 mm, p<0.001).
  
  
  CONCLUSIONS
  The tested sealants demonstrated high sealing efficacy. While BioGlue was superior in resisting higher ventilation pressure, TachoSil possessed better elasticity.
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Ruoyu
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bures
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Höffler
authors.affiliation: Department of Pathology, Hannover Medical School, Hannover, Germany.
authors.forename: Danny
authors.initials: D
authors.lastname: Jonigk
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Krueger
mesh_terms: D000818:Animals; D004338:Drug Combinations; D004548:Elasticity; D005260:Female; D005340:Fibrinogen / Q000737:chemistry / Q000494:pharmacology*; D066298:In Vitro Techniques; D008297:Male; D011030:Pneumothorax / Q000628:therapy*; D011312:Pressure; D011506:Proteins / Q000737:chemistry / Q000494:pharmacology*; D011650:Pulmonary Alveoli / Q000473:pathology / Q000601:surgery*; D012121:Respiration, Artificial; D013552:Swine; D013917:Thrombin / Q000737:chemistry / Q000494:pharmacology*; D014014:Tissue Adhesives / Q000737:chemistry / Q000494:pharmacology*
chemical_list: C472676:Bio-glue; D004338:Drug Combinations; D011506:Proteins; C518955:TachoSil; D014014:Tissue Adhesives; D005340:Fibrinogen; D013917:Thrombin