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Prevention of postoperative pericardial adhesions with hydrophilic polymer solutions
D A Duncan1, Y Yaacobi, E P Goldberg
1Department of Surgery, University of Florida, Gainesville 32610.
Insights
Polyvinylpyrrolidone (PVP) and a methlycellulose derivative (MCD) irrigation solutions significantly reduced pericardial adhesions in dogs. These findings suggest PVP and MCD can prevent adhesions, potentially improving outcomes for cardiac reoperation patients.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Surgical Innovation
Background:
- Pericardial adhesions pose risks during cardiac reoperation, increasing potential for injury.
- Resternotomy in patients with prior cardiac surgery often involves navigating adhesions.
Purpose of the Study:
- To evaluate polyvinylpyrrolidone (PVP) and a methlycellulose derivative (MCD) as irrigating solutions for preventing postoperative pericardial adhesions.
- To assess the efficacy of PVP and MCD in reducing adhesion formation compared to a control solution.
Main Methods:
- Fifteen dogs underwent left thoracotomy and pericardiotomy.
- Pericardial cavities were irrigated with PVP, MCD, or Ringer's lactate (RL) before inducing simulated intraoperative trauma.
- Adhesion formation was evaluated 6 weeks postoperatively by independent observers using a 0-4 scale.
Main Results:
- The Ringer's lactate (RL) control group exhibited significant adhesions (mean score 3.2 +/- 1.1).
- No surgically significant adhesions were observed in dogs treated with PVP or MCD.
- Mean adhesion scores were significantly lower for PVP (0.2 +/- 0.4) and MCD (0.5 +/- 0.7) compared to RL.
Conclusions:
- Both PVP and MCD significantly reduce pericardial adhesion formation compared to RL.
- Clinical use of PVP or MCD may decrease morbidity and mortality associated with cardiac reoperations.
Abstract:
Pericardial adhesions subject patients requiring cardiac reoperation to potential injuries of the heart, great vessels, and extracardiac grafts during resternotomy. We evaluated polyvinylpyrrolidone (PVP) and a methlycellulose derivative (MCD) as intraoperative irrigating solutions in the prevention of postoperative pericardial adhesions. Fifteen dogs weighing 15 to 20 kg were divided into three equal cohorts and subjected to left thoracotomy with pericardiotomy. Prior to surgical manipulation, the pericardial cavity was irrigated with either PVP, MCD, or Ringer's lactate (RL). Serosal injury stimulating intraoperative trauma was induced by gauze sponge abrasion of the epicardium and inner surface of the pericardium and by allowing desiccation of serosal surfaces for 30 min. The pericardial cavity was evaluated for adhesion formation 6 weeks postoperatively by reoperation. Two independent observers, unaware of the study solution, evaluated the extent and severity of pericardial adhesions on a 0-4 scale. All dogs in the RL control group had surgically significant adhesions and a mean adhesion score of 3.2 +/- 1.1. In contrast, no PVP- or MCD-treated dog had surgically significant adhesions. The mean adhesion scores were 0.2 +/- 0.4 for PVP and 0.5 +/- 0.7 for MCD. Our results indicate that PVP (P less than 0.004) and MCD (P less than 0.024) significantly reduce pericardial adhesion formation when compared to RL. Clinical application of PVP or MCD for the prevention of pericardial adhesions should reduce morbidity and mortality of cardiac reoperation.