Elefteriades John A
Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
J Cardiothorac Surg. 2009 Jun 26;4:27. doi: 10.1186/1749-8090-4-27.
Suture-line hemostasis, reinforcement of friable tissue, and adhesion prevention are key concerns for patients undergoing cardiac surgery for aortic reconstruction. Failure to secure hemostasis at anastomotic junctures and reinforce fragile tissue may lead to increased blood loss, additional blood product requirements, increased operative time, and, in extreme cases, reoperation. Patients with aortic pathology may also be at higher risk for reoperation, and adhesion formation from prior surgery is an added risk at resternotomy. The advent of high-pressure sealants has been of benefit in helping to alleviate these perioperative challenges.
The author utilizes two high-pressure sealants for aortic reconstructive procedures. The first is made of two polymers of polyethylene glycol (PEG) [Coseal, Baxter Healthcare, Corporation], and is used to secure anastomotic suture-line hemostasis and for adhesion prevention. The second is a bovine serum albumin-glutaraldehyde (BSAG) glue [BioGlue, CryroLife, Inc.], used for the repair of dissected aortic tissue and in reinforcing ("tanning") fragile aortic tissues. The techniques for application in select aortic reconstruction procedures are described.
To substantiate the hemostatic clinical benefit observed by the author, 60 consecutive major thoracic aortic operations in 57 patients in whom PEG sealant was used were retrospectively reviewed. Although comparisons with other agents were not performed for this descriptive report, bleeding results were very favorable for these types of operations. The strong clinical impression is that topical hemostatic application of PEG sealant to anastomotic suture lines is helpful in preventing bleeding.
In major aortic reconstructive procedures the need for anastomotic sealing performance, reinforcement of friable tissues, and adhesion prevention should not be underrated. High-pressure surgical sealants represent an important surgical adjunct, and the author has found the use of both PEG sealant and BSAG glue advantageous in aortic reconstruction and repair.
对于接受主动脉重建心脏手术的患者而言，缝线止血、加固脆弱组织以及预防粘连是关键问题。在吻合口处未能确保止血以及加固脆弱组织可能导致失血增加、额外的血制品需求、手术时间延长，在极端情况下还需要再次手术。患有主动脉病变的患者再次手术的风险可能也更高，而既往手术形成的粘连在再次开胸手术时会增加风险。高压密封剂的出现有助于缓解这些围手术期挑战。
作者在主动脉重建手术中使用了两种高压密封剂。第一种由两种聚乙二醇（PEG）聚合物制成[Coseal，百特医疗保健公司]，用于确保吻合口缝线止血以及预防粘连。第二种是牛血清白蛋白 - 戊二醛（BSAG）胶水[BioGlue，CryroLife公司]，用于修复主动脉夹层组织以及加固（“鞣制”）脆弱的主动脉组织。描述了在特定主动脉重建手术中的应用技术。
为证实作者观察到的止血临床益处，对57例使用PEG密封剂的患者连续进行的60例主要胸主动脉手术进行了回顾性分析。尽管该描述性报告未与其他药物进行比较，但对于这类手术，出血结果非常理想。强烈的临床印象是，在吻合口缝线上局部应用PEG密封剂有助于预防出血。
在主要的主动脉重建手术中，对吻合口密封性能、加固脆弱组织以及预防粘连的需求不应被低估。高压手术密封剂是一种重要的手术辅助工具，作者发现PEG密封剂和BSAG胶水在主动脉重建和修复中均具有优势。
