Abstract
ObjectiveWe investigated the mobility of a temperature-sensitive poloxamer/Alginate/CaCl2 mixture (PACM) in relation to gravity and cardiac motion and the efficacy of PACM on the prevention of pericardial adhesion in a supine rabbit model.MethodsA total of 50 rabbits were randomly divided into two groups according to materials applied after epicardial abrasion: PACM and dye mixture (group PD; n = 25) and saline as the control group (group CO; n = 25). In group PD, rabbits were maintained in a supine position with appropriate sedation, and location of mixture of PACM and dye was assessed by CT scan at the immediate postoperative period and 12 hours after surgery. The grade of adhesions was evaluated macroscopically and microscopically two weeks after surgery.ResultsIn group PD, enhancement was localized in the anterior pericardial space, where PACM and dye mixture was applied, on immediate post-surgical CT scans. However, the volume of the enhancement was significantly decreased at the anterior pericardial space 12 hours later (P < .001). Two weeks after surgery, group PD had significantly lower macroscopic adhesion score (P = .002) and fibrosis score (P = .018) than did group CO. Inflammation score and expression of anti-macrophage antibody in group PD were lower than those in group CO, although the differences were not significant.ConclusionsIn a supine rabbit model study, the anti-adhesion effect was maintained at the area of PACM application, although PACM shifted with gravity and heart motion. For more potent pericardial adhesion prevention, further research and development on the maintenance of anti-adhesion material position are required.
Highlights
Cardiac surgery is complex and carries a high potential for complications, especially when reoperation is required
In group PD, enhancement was localized in the anterior pericardial space, where poloxamer/Alginate/CaCl2 mixture (PACM) and dye mixture was applied, on immediate post-surgical CT scans
In a supine rabbit model study, the anti-adhesion effect was maintained at the area of PACM application, PACM shifted with gravity and heart motion
Summary
Cardiac surgery is complex and carries a high potential for complications, especially when reoperation is required. Pericardial adhesion from one surgery can greatly complicate subsequent operations. Adhesion prevention is important, especially in relatively young patients who may require another sternotomy in the future for various indications and in pediatric patients who undergo staged operations [1]. Pericardial adhesion prevention must be handled differently from adhesions in other body parts for several reasons. The heart is an actively moving anatomic structure. Pericardial adhesion must be prevented in all three-dimensional planes in both original and reconstructed anatomic structures, such as coronary bypass grafts, patches, conduits, and great vessels[1]
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