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DOI: 10.1055/s-2005-862094
A novel adhesion barrier facilitates reoperations in complex congenital cardiac surgery
Objective: Aim of this study was to prospectively evaluate a bioresorbable membrane to prevent adhesions after surgery for congenital heart defects.
Material and Methods: The surgical membrane (CV Seprafilm™, Genzyme, Cambridge MA, USA) was applied in 350 out of 1024 patients over a three and a half year period. 30 of them underwent reoperation and were evaluated in comparison to 10 random reoperated patients. Adhesions were evaluated using a subjective scoring system [1 (lowest) to 5 (highest tenacity)] at different regions of the heart.
Results: Patients were operated for atrioventricular septal defect (69), tetralogy of Fallot (65), functional single ventricle (75), valve surgery (48), ventricular septal defect (20), subaortic stenosis (17), hypoplastic left heart syndrome (17), and other diagnoses (39). Application of the surgical membrane was safe in all patients without any infections. At reoperations patients received Glenn (14), total cavopulmonary connection (6), and others (10). Overall mortality was 2 / 350 (0.57%). There was a remarkable reduction in tenacity score (3.3 versus 4.3) and in the extent of adhesions (77.7 versus 86%). Duration of reoperation was significantly reduced.
Conclusions: A bioresorbable surgical membrane leads to a significant reduction in the tenacity and amount of adhesions. It has to be recommended for general use whenever repeat operation is anticipated in congenital as well as in adult cardiac surgery.