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Orhan A, Görmüş N, Toy H, Görmüş IS, Çağlayan O, Tanyeli Ö. Prevention of Retrosternal Pericardial Adhesions After Cardiac Surgery With Mitomycin C. Heart Lung Circ 2014; 23:357-62. [DOI: 10.1016/j.hlc.2013.10.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/10/2013] [Accepted: 10/12/2013] [Indexed: 11/26/2022]
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2
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de Oliveira PPM, Bavaresco VP, Silveira-Filho LM, Schenka AA, Vilarinho KADS, Barbosa de Oliveira Severino ES, Petrucci O. Use of a novel polyvinyl alcohol membrane as a pericardial substitute reduces adhesion formation and inflammatory response after cardiac reoperation. J Thorac Cardiovasc Surg 2014; 147:1405-10. [DOI: 10.1016/j.jtcvs.2013.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 06/27/2013] [Accepted: 07/03/2013] [Indexed: 11/16/2022]
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3
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Boyd WD, Tyberg JV, Cox JL. A review of the current status of pericardial closure following cardiac surgery. Expert Rev Cardiovasc Ther 2013; 10:1109-18. [PMID: 23098147 DOI: 10.1586/erc.12.87] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Some cardiac surgeons prefer to close the pericardium whenever possible following surgery, others specifically avoid this practice, and still others believe that neither alternative has any meaningful influence on clinical outcomes. Unfortunately, scientific evidence supporting either approach is scarce, making a consensus regarding best practice impossible. In this article, the known functions of the native intact pericardium are summarized, and the arguments for and against pericardial closure after surgery are examined. In addition, the techniques and materials that have been utilized for pericardial closure previously, as well as those that are currently being developed, are assessed.
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Affiliation(s)
- W Douglas Boyd
- University of California Davis Medical Center, Davis, CA, USA.
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4
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Kaushal S, Patel SK, Goh SK, Sood A, Walker BL, Backer CL. A novel combination of bioresorbable polymeric film and expanded polytetrafluoroethylene provides a protective barrier and reduces adhesions. J Thorac Cardiovasc Surg 2011; 141:789-95. [DOI: 10.1016/j.jtcvs.2010.11.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/08/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
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5
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Scherner M, Strauch JT, Haldenwang PL, Baer F, Wahlers T. Successful transapical aortic valve replacement in a patient with a previous mechanical mitral valve replacement. Ann Thorac Surg 2009; 88:1662-3. [PMID: 19853130 DOI: 10.1016/j.athoracsur.2009.04.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 04/06/2009] [Accepted: 04/13/2009] [Indexed: 10/20/2022]
Abstract
In this case we illustrate our experience with transapical minimal invasive aortic valve replacement in a patient who previously underwent mitral valve replacement. The implantation did not interfere with the existing prosthesis and could even be used as a further landmark, helping height positioning of the aortic valve.
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Affiliation(s)
- Maximilian Scherner
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
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6
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Inflammatory response to bovine pericardium: reply to letter by Davila. Int Urogynecol J 2006. [DOI: 10.1007/s00192-006-0078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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7
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Lazarou G, Powers K, Pena C, Bruck L, Mikhail MS. Inflammatory reaction following bovine pericardium graft augmentation for posterior vaginal wall defect repair. Int Urogynecol J 2004; 16:242-4. [PMID: 15378236 DOI: 10.1007/s00192-004-1230-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 08/19/2004] [Indexed: 11/27/2022]
Abstract
Graft augmentation for repair of recurrent pelvic organ prolapse is commonly used in reconstructive pelvic surgery. The reported complications are mainly late onset. We report a case of early-onset inflammatory reaction following bovine pericardium graft augmentation for posterior vaginal wall defect repair. A 49-year-old presented with a recurrent and symptomatic posterior vaginal wall defect. She underwent an uneventful site-specific repair and bovine graft augmentation. Her early postoperative course was complicated by inflammatory response to the graft presenting as intense pelvic floor spasm and urinary retention. The condition was managed conservatively and resolved subsequently. One year later, the patient continues to be asymptomatic. Transient intense pelvic floor spasm and urinary retention can be the result of inflammatory reaction following graft augmentation with bovine pericardium for posterior vaginal wall defect repair.
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Affiliation(s)
- George Lazarou
- Department of Obstetrics and Gynecology and Women's Health, Division of Female Pelvic Medicine and Reconstructive Surgery, Albert Einstein College of Medicine/Montefiore Medical Center Bronx, NY 10467, USA.
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8
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Pais VM, Jiang Z, Fung LCT. Foreign body reaction to bovine pericardium: a previously unreported complication of pediatric chordee repair. J Urol 2002; 168:702-3; discussion 703. [PMID: 12131354 DOI: 10.1016/s0022-5347(05)64728-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Vernon M Pais
- Division of Urology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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9
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Foreign Body Reaction to Bovine Pericardium:. J Urol 2002. [DOI: 10.1097/00005392-200208000-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Nkere UU. Postoperative adhesion formation and the use of adhesion preventing techniques in cardiac and general surgery. ASAIO J 2000; 46:654-6. [PMID: 11110260 DOI: 10.1097/00002480-200011000-00003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The formation of postoperative adhesions is an inevitable sequel to surgical intervention, and, as part of the healing process, they are often beneficial. Nevertheless, the presence of adhesions may impose postoperative and reoperative surgical problems. An overview of some of the attempts to overcome such problems is presented, and the research surrounding them is discussed.
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Affiliation(s)
- U U Nkere
- Cardiothoracic Surgery Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Lahtinen J, Satta J, Lähde S, Suramo I, Nissinen J, Pokela R, Juvonen T. Computed tomographic evaluation of retrosternal adhesions after pericardial substitution. Ann Thorac Surg 1998; 66:1264-8. [PMID: 9800817 DOI: 10.1016/s0003-4975(98)00588-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Reoperative median sternotomy can result in cardiac injury and serious bleeding, with the rate ranging from 2% to 6%. Closure of the native pericardium can maintain a preventing plane of cleavage. In patients in whom primary pericardial closure is not possible, several substitutes have been tried with variable results. We conducted a prospective study to evaluate the clinical feasibility of polytetrafluoroethylene and polyglycolic acid patches as pericardial substitutes, using computed tomography for imaging the postoperative state of the retrosternal space. METHODS The basic population comprised 540 patients who were scheduled for coronary artery bypass grafting, and 52 of them who met the research criteria were chosen for computed tomographic evaluation after 5 years after the primary operation. RESULTS As a substitute, polytetrafluoroethylene seemed to be less adhesive to the posterior surface of the sternum. Total adhesion scores were also statistically significant (p < 0.001) to the advantage of polytetrafluoroethylene over polyglycolic acid as a pericardial substitute. CONCLUSIONS Polytetrafluoroethylene membrane seems to be capable of minimizing retrosternal adhesion formation and thus it may protect the heart during subsequent reoperative sternotomy.
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Affiliation(s)
- J Lahtinen
- Department of Surgery, Oulu University Hospital, University of Oulu, Finland
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12
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Okuyama N, Rodgers KE, Wang CY, Girgis W, Oz M, St Amand K, Pines E, DeCherney AH, Rose EA, Cohn D, diZerega GS. Prevention of retrosternal adhesion formation in a rabbit model using bioresorbable films of polyethylene glycol and polylactic acid. J Surg Res 1998; 78:118-22. [PMID: 9733628 DOI: 10.1006/jsre.1998.5317] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to test the efficacy of three bioresorbable films of polyethylene glycol (EO) and polylactic acid (LA) (EO/LA = 1.5, 2.5, and 3.0) in the prevention of adhesion formation between the epicardium and the sternum (retrosternal adhesions) in a rabbit model. Retrosternal adhesions were generated by sternotomy, pericardiotomy, and abrasion of the anterior epicardium. The adhesion barrier was placed between the epicardium and the sternum and sutured to the edge of the pericardium. Epicardial adhesions were evaluated 14-20 days later by assessing the area of the epicardium covered by adhesions. In the control rabbits, tenacious adhesions were observed between sternum and the central portion of epicardium (portion exposed through the pericardiotomy) which were difficult to dissect. When a bioresorbable film was placed over the pericardium, adhesion formation at the central strip of the epicardium (area between the sternum and the epicardium exposed through the pericardium) could be reduced or prevented. At this site, the areas of adhesion formation were 0% (EO/LA = 1.5), 8.4 +/- 2.8% (EO/LA = 2.5), and 5.6 +/- 4.7% (EO/LA = 3.0) of the central strip, significantly less than that observed in the control group, 78.0 +/- 5.8% (P < 0.01). At the anterior left and right and posterior apex of the heart (sites where the film was not placed), there were no differences between control and treatment groups. The films were completely resorbed at the time of necropsy in group EO/LA = 2.5 and 3.0. Small pieces of film were observed in group EO/LA = 1.5. In conclusion, the bioresorbable films [EO/LA = 1.5 (REPEL-CV), 2.5, or 3.0] were efficacious in the reduction of retrosternal adhesions to the epicardium.
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Affiliation(s)
- N Okuyama
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, 90033, USA
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Krause TJ, Goldsmith NK, Ebner S, Zazanis GA, McKinnon RD. An inhibitor of cell proliferation associated with adhesion formation is suppressed by N,O-carboxymethyl chitosan. J INVEST SURG 1998; 11:105-13. [PMID: 9700618 DOI: 10.3109/08941939809032189] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Surgical adhesions are a major cause of morbidity and mortality. The ideal barrier agent will both minimize adhesions and provide a milieu for the regeneration of the mesothelium lining of the abdominal and thoracic cavities. N,O-Carboxymethylchitosan (NOCC), a derivation of chitin that markedly reduces adhesions, may function to modulate intracellular signals such as growth factors and cytokines in the inflammatory exudate. Since transforming growth factor-beta is implicated in the fibrotic process, we investigated the possibility that NOCC's effects on adhesion formation reflects a modulation of TGF-beta activity. Using a biological assay for inhibition of cell proliferation to detect TGF-beta activity, we demonstrate that NOCC suppresses the levels of an inhibitor of cell proliferation released into serum and peritoneal exudates after cecal abrasion in the rat. However, this activity was distinct from known forms of TGF-beta as determined using both TGF-beta-neutralizing antisera and a TGF-beta-resistant cell proliferation assay. Thus at least one potential effect of NOCC involves a mechanism distinct from TGF-beta inhibition.
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Affiliation(s)
- T J Krause
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, Piscataway, USA
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Oswal D, Woo EB, Kay PH, McLenachan JM. Haemodynamic performance of a 16-mm Carbomedics aortic prosthesis. Eur J Cardiothorac Surg 1997; 11:1183-4. [PMID: 9237609 DOI: 10.1016/s1010-7940(97)01158-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 55-year-old lady underwent repeat aortic valve replacement using a 16-mm Carbomedics prosthesis. She made an uneventful postoperative recovery and now leads an unrestricted life. Doppler echocardiography reveals a 21-mm Hg gradient across the valve at rest. This did not increase with an infusion of 30 mcg/kg per min of dobutamine, which resulted in an increase in the cardiac output from 1.96 to 5.46 l/min.
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Affiliation(s)
- D Oswal
- The Department of Cardiothoracic Surgery, The Leeds General Infirmary, UK
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Hurlé A, de la Vega M, Feijóo JJ, Ray VG, Abad C, Ponce G, Pérez-Arellano JL. Effect of physical protection on the mesothelial integrity of the pericardium. Ann Thorac Surg 1997; 63:1091-4. [PMID: 9124911 DOI: 10.1016/s0003-4975(96)01389-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mesothelial integrity is essential for the prevention of pericardial adhesions. This study was performed to determine the effect of physical protection of the pericardium on mesothelial integrity. METHODS A pericardial biopsy specimen was obtained at the time of pericardiotomy (0 minutes) in 10 patients undergoing a cardiac operation for the first time. The left free edge of the pericardiotomy was plicated inward to protect the mesothelium. Biopsy specimens were obtained from the protected and unprotected pericardium at 45 and 90 minutes after the start of extracorporeal circulation. Mesothelial integrity and the local inflammatory response were then assessed and graded histologically. RESULTS The mesothelium was found to be present in the protected specimens at 0, 45, and 90 minutes, but it was found to be denuded in the unprotected specimens (p = 0.003 at 45 minutes; p = 0.004 at 90 minutes). Local inflammation was totally established in both the protected and unprotected specimens at 45 minutes. CONCLUSIONS Physical agents appear to be the main factor that is damaging to the pericardial mesothelium, and this is an important concept to be taken into consideration when designing a method to prevent pericardial adhesions.
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Affiliation(s)
- A Hurlé
- Department of Cardiovascular Surgery, Hospital N. S. del Pino, Las Palmas de Gran Canaria, Canary Islands, Spain.
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Chanda J, Kuribayashi R, Abe T. Use of the glutaraldehyde-chitosan-treated porcine pericardium as a pericardial substitute. Biomaterials 1996; 17:1087-91. [PMID: 8718968 DOI: 10.1016/0142-9612(96)85909-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The efficacy of chitosan post-treatment of glutaraldehyde-treated porcine pericardial substitute for the prevention of postoperative epicardial reaction and adhesion formation in mongrel dogs has been assessed. Glutaraldehyde (0.625%)-treated porcine pericardium showed moderate to dense adhesions to the heart and other underlying organs with moderate to severe epicardial reaction. None to minimal epicardial reaction without adhesion was observed in glutaraldehyde-treated porcine pericardium post-treated with chitosan at 5 months. Presumably, chitosan post-treatment prevents the slow release of residual glutaraldehyde and reduces the toxicity of the glutaraldehyde-treated implants, minimizing the chance of adhesion formation and epicardial reaction.
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Affiliation(s)
- J Chanda
- Department of Cardiovascular Surgery, Akita University School of Medicine, Japan
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Mitchell JD, Lee R, Hodakowski GT, Neya K, Harringer W, Valeri CR, Vlahakes GJ. Prevention of postoperative pericardial adhesions with a hyaluronic acid coating solution. J Thorac Cardiovasc Surg 1994. [DOI: 10.1016/s0022-5223(12)70149-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Foreign materials found in the cardiovascular system after instrumentation or surgery (Including a guide to their light microscopic identification). Cardiovasc Pathol 1993; 2:157-85. [DOI: 10.1016/1054-8807(93)90001-i] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/1993] [Accepted: 03/09/1993] [Indexed: 11/18/2022] Open
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Regas ML. Reoperative cardiac surgery. Challenges, perioperative nursing considerations. AORN J 1993; 57:1131, 1134-5, 1138-48. [PMID: 8489225 DOI: 10.1016/s0001-2092(07)67319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M L Regas
- Indiana University Medical Center, Indianapolis
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20
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Wiseman DM, Kamp L, Linsky CB, Jochen RF, Pang RH, Scholz PM. Fibrinolytic drugs prevent pericardial adhesions in the rabbit. J Surg Res 1992; 53:362-8. [PMID: 1405617 DOI: 10.1016/0022-4804(92)90062-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Epicardial adhesions are believed to form secondarily to impaired pericardial fibrinolytic activity. This activity was reconstituted in a rabbit pericardial adhesion model with single doses of the fibrinolytic agents tissue plasminogen activator (t-PA), t-PA analog (Fb-Fb-CF), and streptokinase (SK), resulting in reductions in the extent and tenacity of adhesion formation. Adhesions of the median strip of the anterior cardiac surface were reduced in area from 89% (n = 22) in controls, to 28% (n = 5) by treatment with Fb-Fb-CF (0.94 mg), and to 49% (n = 7) by treatment with SK (93,750 IU). A modified fabric of oxidized regenerated cellulose (mTC7) used to deliver the agent to the cardiac surface did not interfere with the activity of these agents (Fb-Fb-CF 19%, n = 14; SK 33%, n = 7). t-PA (0.94 mg) was also found to reduce adhesion formation in combination with mTC7 (4%, n = 4), although the appearance of significant postoperative bruising and bleeding resulted in a decision to terminate the treatment of further animals with t-PA with and without mTC7. Postoperative bruising, bleeding, and swelling, to a lesser extent, were associated with SK and Fb-Fb-CF. Despite the efficacy of the these fibrinolytic drugs further work is required to assess their safety before they are used clinically.
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Affiliation(s)
- D M Wiseman
- Adhesions Research, Johnson & Johnson Medical, Inc. (presently Adhesions Research, Ethicon, Inc.), Somerville, New Jersey 08876
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