Short Phase Efficacy of Autologous Peritoneum as a Pericardial Substitute

Abstract

The risks associated with resternotomy are largely related to loss of pericardial integrity. No satisfactory substitute for pericardium has been identified. The structural similarity between pericardium and peritoneum prompted an assessment of the latter as a biologic substitute. Two peritoneal patches were harvested from four juvenile swine, which then underwent left thoracotomies. In each pig, two pericardial defects were created and repaired with fresh and glutaraldehyde treated autologous peritoneal patches. Three weeks post operatively, the chest and abdomen were re-explored and the patches evaluated. In all cases, extrapericardial adhesions were insignificant. On gross examination of the intrapericardial surfaces, the fresh patches appeared smooth and glistening, with neither degenerative changes nor adherence to the epicardium. The treated patches were easily separated from the epicardium in two cases, but the other two patches were moderately to severely adherent. Histologic examination demonstrated well preserved morphology in all patches. C proline uptake and autoradiography revealed preserved fibroblast viability in the fresh patches. Intra abdominally, in all cases, there was complete reperitonealization without adhesion formation. In conclusion, fresh autologous peritoneum performed well as a pericardial substitute after heart surgery.