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Repeat sternotomy after reconstruction of the pericardial sac with glutaraldehyde-preserved equine pericardium
Insights
Closing pericardial defects with equine pericardial patches significantly reduces adhesions during repeat sternotomy. This method is safe and effective for patients needing reoperation after open heart surgery.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Repeat sternotomy poses higher risks, particularly if the pericardial sac is left open after initial open heart operations.
- Pericardial adhesions can complicate reoperations, increasing surgical difficulty and patient risk.
Purpose of the Study:
- To evaluate the efficacy of glutaraldehyde-preserved equine pericardial patches in closing pericardial defects.
- To assess the impact of pericardial closure on precardiac adhesions during reoperation.
Main Methods:
- A study of 200 patients with pericardial defects after open heart surgery.
- Patients were divided into groups based on whether the pericardium was left open or reconstructed with an equine pericardial patch.
- Precardiac adhesions were graded during reoperation; follow-up for patch-related complications was conducted.
Main Results:
- Patients with reconstructed pericardial sacs (Group II) showed significantly less severe adhesions (mean grade 1.6) compared to those with open defects (Group I, mean grade 3.2).
- No significant difference in adhesion severity was found between early and late reoperations when the pericardium was left open.
- Patch-related complications occurred in only 1% of patients after a mean follow-up of 20.2 months.
Conclusions:
- Glutaraldehyde-preserved equine pericardial patches are effective in closing pericardial defects.
- Patch closure significantly reduces precardiac adhesions during repeat sternotomy, improving surgical outcomes.
- Equine pericardial patches are a suitable material for primary closure of the pericardial sac when autologous pericardium is insufficient.
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.