The use of Tachosil® surgical patch or fibrin glue in coronary artery surgery does not affect quality of anastomosis or provoke postoperative adhesions in pigs

Abstract

Fibrin glue products and collagen surgical patches (TachoSil) coated with coagulation factors I and IIa are increasingly being used to prevent oozing from distal or proximal coronary anastomosis. Furthermore, an increasing number of patients are being operated upon anti-platelet therapy. These patients often exhibit diffuse bleeding. Especially in an off-pump scenario surgeons refrain from placing additional stitches in order to avoid an impairment of the graft. In these situations, a biological glue can help resolve this dilemma. It is, however, assumed that these products may exert negative effects on the anastomosis. For obvious reasons a systematic histological assessment in humans is impossible. Therefore, a chronic, large animal model was developed to study the fate of these products on a coronary anastomosis. In 15 pigs receiving off-pump coronary artery bypass graft of the left mammary artery to the left anterior descending coronary artery, three groups were defined. Group A served as control. In group B the anastomosis was covered with 1 ml fibrin glue; in group C TachoSil coverage was performed. Bypass flow (BF) was measured using a Doppler probe. After 3 months the pigs were sacrificed and the anastomoses were evaluated macroscopically and by means of light microscopy regarding patency and fibrosis. In group A, all five animals survived, three of the five anastomoses were patent and the mean BF was 26 ml min(-1). In group B, three of the five animals survived, all anastomoses were patent. The BF was 21 ml min(-1). In group C, all five animals survived, four of the five anastomoses were patent and BF was 21 ml min(-1). Macroscopic and histological evaluation showed no differences between the groups. Remnants of Tachosil or fibrin glue were not observed. In the chronic course, no evidence of adverse effects of TachoSil or fibrin glue was noted. Both agents can therefore be used safely in clinical practice for haemostyptic or positioning purposes.