Repeat sternotomy after reconstruction of the pericardial sac with glutaraldehyde-preserved equine pericardium.
Abstract: The risk of repeat sternotomy is higher than that of the initial sternotomy, especially if the pericardial sac was left open at the first intervention. In 200 consecutive patients with a pericardial defect after open heart operations, the pericardium was closed with a glutaraldehyde-preserved equine pericardial patch. Precardiac adhesions at reoperation were assessed in four groups of patients on a scale of 6, ranging from 0 (no adhesions) to 5 (calcified or ossified adhesions). Group I comprised 13 patients in whom the pericardium was left open at the first operation and an equine pericardial patch was implanted at reoperation. Group Ia included the first five Group I patients who underwent reoperation less than 1 year (early reoperation) after the initial procedure. Group Ib included the other eight patients of Group I, who underwent reoperation more than 1 year (late reoperation) after the first procedure. Group II comprised nine patients who were reoperated on after reconstruction of the pericardial sac with a glutaraldehyde-preserved equine pericardial patch. After a mean follow-up of 20.2 months, the incidence of patch-related complications was 1%. Statistical analysis shows less severe adhesions on reoperation in Group II patients (pericardial defect patched) than in Group I patients (pericardial defect left open): mean grade of adhesions 1.6 +/- 0.9 (Group II) versus 3.2 +/- 0.6 (Group I), p less than 0.001. Precardial adhesions with the pericardium left open were similar in patients having early and late reoperations: mean grade of adhesions 3.0 +/- 0.7 (Group Ia) versus 3.4 +/- 0.5 (Group Ib), no significant difference. Therefore, the glutaraldehyde-preserved equine pericardial patch can be considered a suitable material for primary closure of the pericardial sac in patients with inadequate autologous pericardium.
Publication Date: 1987-04-01 PubMed ID: 3104694
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- Comparative Study
- Journal Article
Summary
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The research investigated the effects of using a glutaraldehyde-preserved equine pericardial patch to close a pericardial defect in patients, assessing the severity of adhesions on reoperation.
Research Context and Aim
- The study was concerned with addressing a problem in cardiac surgery related to repeat sternotomy (a type of surgical procedure that provides access to the heart and lungs) particularly when the pericardial sac (the double-walled sac that contains the heart) was left open during an initial operation. The risk of complications during a repeat sternotomy is higher than the initial operation.
- The research aim was to investigate whether using a glutaraldehyde-preserved equine pericardial patch (a patch made from horse pericardium treated with glutaraldehyde to increase durability and decrease immunoreactivity) to close the pericardial defect decreases severe adhesions (an internal scar that binds together usually separate anatomical parts) during reoperation.
Research Design and Groups
- This study involved 200 patients with a pericardial defect after open heart operations in which their pericardium was closed using a glutaraldehyde-preserved equine pericardial patch. The severity of precardiac adhesions during reoperation was assessed on a scale of 0 (no adhesions) to 5 (calcified or ossified adhesions).
- The patients were divided into four groups. Group I consisted of 13 patients who had their pericardium left open during their first operation, and had an equine pericardial patch implanted during their reoperation. Group I was further divided into Group Ia and Ib, consisting of those who underwent reoperation less than a year, and more than a year after the first procedure respectively. Group II contained 9 patients who had a reoperation after pericardial sac reconstruction with the equine pericardial patch.
Results and Analysis
- Follow-up after about 20 months showed that the incidence of patch-related complications was just 1%.
- Statistically, the study found that there were less severe adhesions on reoperation in Group II (those patched), compared to Group I (pericardial defect was left open). The severity of adhesions was found to be similar in patients who had early and late reoperations when the pericardium was left open
- The study concluded that the glutaraldehyde-preserved equine pericardial patch can be considered as a suitable material for primary closure of the pericardial sac in patients with inadequate autologous pericardium.
Cite This Article
APA
von Segesser L, Jornod N, Faidutti B.
(1987).
Repeat sternotomy after reconstruction of the pericardial sac with glutaraldehyde-preserved equine pericardium.
J Thorac Cardiovasc Surg, 93(4), 616-619.
Publication
Researcher Affiliations
MeSH Terms
- Adolescent
- Adult
- Animals
- Bioprosthesis / adverse effects
- Cardiomyopathies / etiology
- Child
- Child, Preschool
- Female
- Glutaral
- Horses
- Humans
- Infant
- Male
- Pericardium / transplantation
- Reoperation
- Sternum / surgery
- Tissue Adhesions / etiology
- Tissue Preservation
- Transplantation, Heterologous
Citations
This article has been cited 6 times.- Elassal AA, Al-Radi OO, Zaher ZF, Dohain AM, Abdelmohsen GA, Mohamed RS, Fatani MA, Abdelmotaleb ME, Noaman NA, Elmeligy MA, Eldib OS. Equine pericardium: a versatile alternative reconstructive material in congenital cardiac surgery.. J Cardiothorac Surg 2021 Apr 23;16(1):110.
- Iop L, Palmosi T, Dal Sasso E, Gerosa G. Bioengineered tissue solutions for repair, correction and reconstruction in cardiovascular surgery.. J Thorac Dis 2018 Jul;10(Suppl 20):S2390-S2411.
- Spiliopoulos K, Markakis C, Tomos P, Gakiopoulou H, Nikolopoulos I, Spartalis E, Kontzoglou K, Safioleas M. Repair of gastric defects with an equine pericardial patch.. Surg Today 2015 Jan;45(1):83-90.
- Vulev I, Klepanec A, Bazik R, Balazs T, Illes R, Steno J. Endovascular treatment of internal carotid and vertebral artery aneurysms using a novel pericardium covered stent.. Interv Neuroradiol 2012 Jun;18(2):164-71.
- Xi-xun Y, Fei L, Yuan-ting X, Chang-xiu W. In vitro study in the endothelial cell compatibility and endothelialization of genipin-crosslinked biological tissues for tissue-engineered vascular scaffolds.. J Mater Sci Mater Med 2010 Feb;21(2):777-85.
- Loebe M, Alexi-Meskhishvili V, Weng Y, Hausdorf G, Hetzer R. Use of polytetrafluoroethylene surgical membrane as a pericardial substitute in the correction of congenital heart defects.. Tex Heart Inst J 1993;20(3):213-7.
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