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Histologic evaluation of stapled right atrial appendages with fabric buttressing
Hideyuki Fumoto1, A Marc Gillinov, D Geoffrey Vince
1Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Objective:
The aim of this study was to histologically evaluate the importance of using buttressing materials in stapling the atrial appendages.
Methods:
We stapled the right atrial appendage with a commercial apparatus in 11 mongrel dogs. To evaluate the efficiency of using a buttressing material as an adjunct to stapling, we conducted 30-day studies without (group A: n = 2) or with buttressing material (group B: n = 3) and 90-day studies without (group C: n = 3) or with buttressing material (group D: n = 3) and thereafter made assessments using Doppler echocardiography and performed histologic analyses on all stapled appendages.
Results:
During surgery, blood oozing from the stapling sites was observed in four of five cases of groups A and C; with buttressing, there was no oozing in groups B and D. In groups A and B, we observed the myocardium of the appendage being focally replaced with fibrous tissue. Myocardium in group C was infiltrated diffusely with loose fibrous tissue and in group D had been almost completely replaced with fibrous tissue.
Conclusions:
The buttressing material was useful not only in preventing oozing but also likely promoting the growth of fibrous tissue in the right atrial appendage.
