Control of major pulmonary artery bleeding with a gelatin matrix-thrombin solution: a retrospective analysis.
BACKGROUND
Intraoperative pulmonary artery (PA) bleeding is common during thoracic surgery. We investigated the efficacy of the gelatin matrix-thrombin solution FloSeal (Baxter International, Deerfield, IL, USA) for control of major PA bleeding.


METHODS
Retrospective data were collected on all intraoperative PA injuries during open or minimally invasive lobectomy or pneumonectomy between January 2000 and January 2014. Patients received either 4/0 prolene sutures (Standard) or the gelatin matrix-thrombin solution, plus sutures as needed (Matrix), with at least 6-month follow-up. Endpoints included time to hemostasis, total blood loss, transfusion and complications.


RESULTS
Of 2809 procedures, 39 (1.4%) had intraoperative PA injury, of which 21 received standard care and 18 the gelatin matrix-thrombin solution. Hemostasis was achieved in all Standard group patients after 2 minutes, and after 5 minutes in Matrix patients. Additional sutures were required in 4 (19.0%) Standard group patients. Three (16.7%) Matrix patients had a second solution application, while 17 (77.8%) received precautionary sutures. Mean blood loss on postoperative day 1 was 836.1±186.1 mL and 957.1±163.0 mL in the Matrix and Standard groups, respectively (P=0.003). Four (22.2%) Matrix patients received postoperative transfusions versus eight (38.0%) Standard patients (P=0.02). Two Standard and no Matrix patients underwent surgical revision. There were no complications and no mortalities.


CONCLUSIONS
Our analysis suggests that the gelatin matrix-thrombin solution is safe and effective for the control of major bleeding following intraoperative PA injury, and may improve outcomes. Further prospective studies are required to confirm our findings.
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy - gcardillo@scamilloforlanini.rm.it.
Giuseppe
G
Cardillo
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy.
Francesco
F
Carleo
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy.
Marco
M
DI Martino
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy.
Bernardo
B
Ciamberlano
Unit of Radiology, Carlo Forlanini Hospital, Rome, Italy.
Pasquale
P
Ialongo
Unit of Thoracic Surgery, Vittorio Emanuele Polyclinic, Catania, Italy.
Giacomo
G
Cusumano
Unit of Cardiology, San Camillo Hospital, Rome, Italy.
Maria
M
Denitza Tinti
Unit of Pulmonology, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
Alberto
A
Ricci
Unit of Thoracic Surgery, Bellinzona e Valli Regional Hospital, Bellinzona, Switzerland.
Stefano
S
Cafarotti
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects / Q000627:therapeutic use*; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011651:Pulmonary Artery / Q000187:drug effects* / Q000293:injuries / Q000601:surgery; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery
C411004:FloSeal Matrix; D006490:Hemostatics