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Prevention of postoperative pericardial adhesions with a novel regenerative collagen sheet
Hiroyuki Tsukihara1, Shinichi Takamoto, Kazuo Kitahori
1Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Background:
Postoperative pericardial adhesions make a repeat sternotomy time-consuming and dangerous. The purpose of this study was to evaluate the efficacy of a new collagen pericardial substitute for preventing postoperative pericardial adhesions.
Methods:
Our absorbable substitute consists of three layers: a middle layer of aterocollagen between two layers of sodium hyaluronic acid and aterocollagen. In experiment 1 in this study, the patch, made of 9,000 filaments of aterocollagen fibers, (group 1; n = 5) was compared with a patch made of 6,000 filaments (group 2; n = 7), an expanded polytetrafluoroethylene sheet (group 3; n = 6), and a control group (group 4; n = 4). Subsequently, in experiment 2, the patch was examined at 4 weeks (n = 5), 12 weeks (n = 5), and 24 weeks (n = 4) after the operation by light microscopy and scanning electron microscopy.
Results:
The area of adhesion in group 1 was significantly less as compared with that in the other three groups, and the coronary vessels were clearly identifiable; on the other hand, all the animals in the control group showed moderate to severe adhesions, and the coronary vessels were completely obscured. In experiment 2, formation of a membranous tissue resembling the native pericardial membrane was observed in all animals, and the thickness of this membrane showed a marked increase by 24 weeks after the operation. Light microscopy and scanning electron microscopy also showed the formation of a mesothelium-like lining.
Conclusions:
The new absorbable and regenerative collagen patch seemed to be biocompatible, and its use was associated with minimal adhesion formation and preserved coronary anatomy.
