Pericardial substitutes: delayed reexploration and findings

Area of Science:

• Biomaterials Science
• Surgical Innovation
• Tissue Engineering

Background:

• Pericardial substitutes are used in cardiac surgery to repair or replace damaged pericardium.
• Evaluating the biocompatibility and tissue response to different pericardial substitutes is critical for optimizing surgical outcomes.
• Bovine pericardium, processed with various fixatives, is a common biomaterial for pericardial substitutes.

Observation:

• Two types of glutaraldehyde-preserved bovine pericardial substitutes were implanted in four patients.
• Formalin-fixed substitutes led to dense adhesions and a thick gelatinous peel between the prosthesis and epicardium.
• Ethanol-fixed substitutes resulted in less severe adhesions, ranging from minimal to moderate fibrosis with inflammatory cell infiltration.

Findings:

• Ethanol fixation of bovine pericardial substitutes is associated with a reduced inflammatory and fibrotic response compared to formalin fixation.
• Minimal prosthesis-to-sternum adhesions were observed across all patients, regardless of the fixation method.
• Both formalin and ethanol-fixed pericardial substitutes facilitated easier surgical reentry and showed no associated infections.

Implications:

• Careful washing of bioprosthetic implants to remove residual preservatives is essential to minimize adverse tissue reactions.
• Ethanol fixation may be a preferable method for processing bovine pericardial substitutes to reduce epicardial adhesions.
• These findings can inform the selection and processing of pericardial biomaterials to improve long-term patient outcomes in cardiac surgery.