Autologous fibrin glue--preparation and clinical use in thoracic surgery

A Novel Fibrin Matrix Derived from Platelet-Rich Plasma: Protocol and Characterization

Although fibrin matrices derived from Platelet-Rich Plasma (PRP) are widely used in regenerative medicine, they have some limitations that can hinder their application. Modifying the composition of the PRP-derived fibrin matrix may improve its properties, making it suitable for certain medical uses. Three types of fibrin matrices were obtained: a PRP-derived fibrin matrix (FM), a PRP-derived fibrin matrix with a high fibrinogen content and platelets (FM-HFP) and a PRP-derived fibrin matrix with a high fibrinogen content (FM-HF). The fibrinogen levels, biomechanical properties and cell behavior were analyzed. The presence of platelets in the FM-HFP generated an inconsistent fibrin matrix that was discarded for the rest of the analysis. The fibrinogen levels in the FM-FH were higher than those in the FM (p < 0.0001), with a concentration factor of 6.86 ± 1.81. The values of clotting and swelling achieved using the FM-HF were higher (p < 0.0001), with less clot shrinkage (p < 0.0001). The FM had a significantly higher stiffness and turned out to be the most adherent composition (p = 0.027). In terms of cell viability, the FM-HF showed less cell proliferation but higher live/dead ratio values (p < 0.01). The increased fibrinogen and platelet removal in the FM-HF improved its adhesion and other biomechanical properties without affecting cell viability.

Clinical Feasibility of Completely Autologous Fibrin Glue in Spine Surgery

Introduction

Fibrin glue is widely used in spine surgery. Nevertheless, no report has demonstrated the feasibility of completely autologous fibrin glue (CAFG) in spine surgery. This study aims to investigate the safety, efficacy, and effect of bone fusion of CAFG on spine surgery.

Methods

We retrospectively extracted data of patients who underwent primary spine surgery with preoperatively prepared CAFG. Primary outcomes were the incidence of wound-related unplanned reoperations within 90 days following primary surgery and the occurrence of reoperation for the management of cerebrospinal fluid (CSF) leakage in patients who had been treated with CAFG used as dural sealants. The effect of CAFG on bone fusion was also assessed by detecting implant failure at one year postoperatively in patients aged 25 years or less undergoing primary fusion for idiopathic scoliosis.

Results

We identified 131 eligible patients (47 males and 84 females) with a mean age of 32.3 years. CAFG was used most frequently as an adhesive for fixation of graft bone (110 patients), followed by as a dural sealant for CSF leakage in 17 patients, and as a local hemostatic agent in four patients. Wound-related reoperations were identified in four patients (3.1%), which included three for surgical site infection, and one for postoperative epidural hematoma. There was no reoperation required for the management of CSF leakage among 17 patients with dural incision or incidental durotomy. Compared with the control cohort, the use of CAFG was not associated with early wound-related reoperations or implant failure in patients with spinal deformity.

Conclusions

We demonstrated the clinical feasibility of CAFG in spine surgery. The use of CAFG was not associated with the incidence of reoperations for wound-related complications. CAFG worked effectively as a dural sealant for preventing CSF leakage. CAFG had no beneficial or adverse effect on spinal bone fusion.

Utility of autologous fibrin glue in the donor site of free abdominal flap for breast reconstruction: A randomized controlled study

BACKGROUND

Seroma formation at the donor site is a common complication of breast reconstruction using free abdominal flap. In this study, we assessed the benefits of use of autologous fibrin glue (AFG) at the donor site.

METHODS

This randomized controlled study compared AFG group (n = 61) with commercial fibrin glue (CFG) group (n = 79). Owing to the high volume of AFG (10 mL), AFG group received fibrin glue at both the anastomosis and the donor sites, whereas CFG group received fibrin glue only at the anastomosis site. Operative protocols and the criteria for postoperative drain removal were identical in both groups. Patient characteristics and abdominal discharge were compared between the two groups.

RESULTS

Since anemia was a contraindication for use of AFG, preoperative Hb in CFG group was significantly lower than that in AFG group; other factors were comparable in the two groups. The mean total abdominal drain volumes on first postoperative day (POD1) and POD2 was (AFG vs. CFG) 130.9 vs. 169.4 mL (P < 0.001) and 131.0 vs. 162.8 mL (P = 0.03), respectively. On POD3, there was no significant difference in this respect (116.2 vs. 128.4 mL, P = 0.19). The mean time for removal of all abdominal drains was significantly lower in AFG group (7.4 vs. 8.4 days; P = 0.01).

CONCLUSIONS

AFG reduced the discharge at the donor site of free abdominal flap, especially in the early postoperative period. AFG helped to reduce the abdominal drainage period.

Feasibility of autologous fibrin glue in general thoracic surgery

Background

Fibrin glue effectively controls air leakage in lung surgery; however, allogenic fibrin glue cannot eliminate the risks of infection and allergy despite current sterilization methods. Autologous fibrin glue (AFG) could be a good alternative, but is not commonly used worldwide because of its limited availability and lack of evidence. Herein, we report clinical outcomes of AFG in thoracic surgery.

Methods

We retrospectively analyzed patients who underwent lobectomies or segmentectomies between November 2016 and September 2017 in our institution. We used two types of AFGs. One was a partially-autologous fibrin glue (PAFG), the components of which are largely autologous but which contains allogenic thrombin. The other was a completely-autologous fibrin glue (CAFG) which has no allogenic components. PAFG was used in the first half of the study period, after which CAFG was used from March 2017 onward. Patients who did not undergo AFG generation were categorized as the non-AFG group. The perioperative outcomes of the three groups were evaluated.

Results

A total of 207 patients underwent lung surgery, including 118 lobectomies and 89 segmentectomies. Among them, 83 patients received PAFG, 94 received CAFG, and 30 received non-AFG. The mean postoperative drainage period was within a few days in each group (PAFG vs. CAFG vs. non-AFG: 3.23±3.91 vs. 3.16±4.04 vs. 3.17±4.16 days, respectively; P=0.405), and the incidence of postoperative prolonged air leakage was within an acceptable range (PAFG vs. CAFG vs. non-AFG: 13.3% vs. 12.8% vs. 16.7%, respectively; P=0.821).

Conclusions

The use of AFG is clinically feasible for patients who undergo lobectomies or segmentectomies. AFGs could be a viable alternative to conventional allogenic fibrin glues.

Autologous Fibrin Glue—Clinical Use and Sealing of High-Porosity Vascular Prostheses

Autologous fibrin glue was prepared in a new way by means of ethanol. From 42 patients 44 mL of blood with a mean plasma fibrinogen concentration of 3.7 mg/mL was drawn. The product of the preparation was a mean of 2.5 mL of fibrinogen concentrate with a concentration of 28 mg/mL. After addition of 0.3 part of thrombin solution containing calcium chloride and aprotinin, an antifibrinolytic agent, the total volume of two-component fibrin glue was 3.3 mL. The preparation was done in a closed system to ensure sterility and com pleted within ninety minutes. Twenty high-porosity double-velour vascular prostheses were sealed with autologous fibrin glue in the laboratory. The pro stheses were tight for blood up to a pressure higher than 300 mmHg, which was comparable to vascular prostheses impregnated with collagen, but to more than twice the pressure of 130 mmHg, where vascular prostheses preclotted with blood started leaking. Autologous fibrin glue imparts a nice white vascular graft with superior handling characteristics, since it is nonsticky compared with blood-clotted grafts and softer and more pliable than the vascular prostheses impregnated with collagen from the manufacturer. In addition autologous fi brin glue has the obvious advantages of safety from transmission of viral dis eases and from immunologic reactions.

Use of a Pericardial Fat Pad for Alveolar Air Leaks after Pulmonary Resections

To investigate the effectiveness of using a free pericardial fat pad to control air leaks from residual raw parenchymal surfaces after pulmonary resections, 30 consecutive patients were studied. There were 23 males and 7 females with a median age of 69 years. The indication for this technique was any alveolar air leak from a residual raw parenchymal surface which could not been controlled by suturing. There were 25 lobectomies with incomplete fissure and 5 cases of segmentectomy. None of the patients exhibited air leaks beyond 2 days, post-operative space problems, or infections. All patients had chest drains removed within 2 days after the operation. The application of a free pericardial fat pad is a promising new method of treating air leaks from residual raw parenchymal surfaces after pulmonary resections.

Biochemical, mechanical, and morphological properties of a completely autologous platelet-rich wound sealant

The optimal composition of fibrin sealant preparations is not known. We, therefore, sought to construct a series of sealants from autologous components and compare their functioning to Bioseal a commonly used sealant. Characteristics of the platelet-rich plasma, cryoprecipitate, and thrombin were determined and compared to commercial glue from composition, function, and microscopy aspects. The concentrations of platelets as well as fibronectin in autologous fibrin glues were significantly higher than those in commercial ones (P < 0.001). Mechanical values (maximum amplitude and clot strength) obtained from thrombelastograph assays in two groups were not significantly different (P > 0.05). A dense platelet surface and fibrin net structures could be observed in the autologous samples, whereas there were only sparse fibrin nets without cellular components in Bioseal. Characterization of autologous and Bioseal fibrin sealants and their performance do not have significant difference in biochemical and mechanical properties. The entirely autologous platelet-rich gel in the present study may get wide application in future practice after confirmation of its safety, efficiency, and economic benefits.

Safety and effectiveness of a new fibrin pleural air leak sealant: a multicenter, controlled, prospective, parallel-group, randomized clinical trial

BACKGROUND

This study evaluated the sealing capacity and safety of a new fibrin sealant (FS) to reduce alveolar air leaks (AALs) after pulmonary resections in a randomized controlled clinical trial conducted in 3 Italian centers.

METHODS

The study randomized (1:1) 185 patients with an intraoperative AAL graded 1 to 3 according to the Macchiarini scale: 91 received FS and 94 had standard lung closure. The primary outcomes were the length of postoperative AAL duration and the mean time to chest drain removal. Other end points included the percentage of patients without AAL, the development of serum antibodies against bovine aprotinin, and any adverse event related to FS. Chest drains were removed when fluid output was 100 mL/day or less, with no air leak.

RESULTS

The study groups were comparable with respect to demographic variables and surgical procedures. The FS group showed a statistically significant reduction in duration of postoperative AALs (9.52 vs 35.8 hours; p < 0.005) and in the percentage of patients with AALs at wound closure (81.11% vs 100%; p < 0.001); the difference in time to chest drain removal was not significant. Pleural empyema developed in 1 patient with FS treatment vs in 4 with standard treatment, and antibodies against bovine aprotinin were found in 34 of 91 FS-treated patients.

CONCLUSIONS

The present study showed that the new FS is safe and effective in preventing AALs after lung resections and in shortening the duration of postoperative AALs.

Multifunctional chondroitin sulphate for cartilage tissue-biomaterial integration

A biologically active, high-strength tissue adhesive is needed for numerous medical applications in tissue engineering and regenerative medicine. Integration of biomaterials or implants with surrounding native tissue is crucial for both immediate functionality and long-term performance of the tissue. Here, we use the biopolymer chondroitin sulphate (CS), one of the major components of cartilage extracellular matrix, to develop a novel bioadhesive that is readily applied and acts quickly. CS was chemically functionalized with methacrylate and aldehyde groups on the polysaccharide backbone to chemically bridge biomaterials and tissue proteins via a twofold covalent link. Three-dimensional hydrogels (with and without cells) bonded to articular cartilage defects. In in vitro and in vivo functional studies this approach led to mechanical stability of the hydrogel and tissue repair in cartilage defects.

A prospective, randomized, controlled trial of the effectiveness of BioGlue in treating alveolar air leaks

OBJECTIVE

The use of tissue glues has been advocated to reduce post-thoracotomy alveolar air leaks, but outcomes have been inconclusive. The aim of this study was to determine the effectiveness of BioGlue (CryoLife Europa Ltd, Hampshire, United Kingdom) in eliminating post-thoracotomy alveolar air leaks.

METHODS

A prospective, randomized, single-blind, controlled trial was conducted in which patients were stratified according to the severity of post-thoracotomy air leak that could not be controlled by conventional surgical techniques. They were allocated to a control arm (surgical treatment only) or an interventional arm (surgical treatment and BioGlue). Duration of air leak, intercostal drainage, and hospital stay comprised primary study end points.

RESULTS

From December 2002 to January 2005, 52 patients were randomized, 29 (56%) of whom were men. The mean age was 59 +/- 15 years, and other characteristics were comparable in both groups. Indications for surgery were malignancy in 46 patients (88%), carcinoid tumor in 2 patients (4%), and infective disease in 4 patients (8%). Patients in the BioGlue arm had shorter median duration of air leaks, 1 (0-2) versus 4 (2-6) days (P < .001); intercostal chest drainage, 4 (3-4) versus 5 (4-6) days (P = .012); and hospital stay, 6 (5-7) versus 7 (7-10) days (P = .004), compared with controls. No major complications were encountered using BioGlue.

CONCLUSIONS

This study demonstrates clear benefit from BioGlue in the treatment of alveolar air leaks through reduction of air leak duration, chest drainage time, and hospital stay. Systematic use of BioGlue may be warranted in adult thoracic surgical procedures (except pneumonectomy and decortication) when an air leak remains after all other steps to control it have failed.

Autologous fibrin glue with growth factors in reconstructive maxillofacial surgery

The aim of this paper was to describe a method for the preparation of autologous fibrin glue with platelet growth factors and to report its use with particulate cancellous bone in reconstructive maxillofacial surgery. The fibrin glue is a two-component glue, where the one component is a concentrated fibrinogen solution with platelet growth factors and the other component is a thrombin solution. Both components were produced from the patients own blood, thus making the glue entirely autologous. The glue was prepared from platelet rich plasma separated from 200 ml of the patient's blood prior to the operation. The fibrinogen in the glue was precipitated from the platelet rich plasma by ethanol precipitation at low temperature and separated together with the platelets by centrifugation. Raising the temperature to 37 degrees C redissolved the precipitate. The thrombin solution in the glue was produced from prothrombin precipitated from 10 ml of the platelet rich plasma by lowering the pH and the ionic strength. The precipitate was separated by centrifugation and dissolved in a calcium ion solution. Increasing the pH to neutral value induced activation to thrombin. Preparation of the fibrin glue was performed in the blood bank within 60 to 90 min with the use of standard equipment. The outcome from 200 ml of blood was approximately 8 ml of fibrin glue: 6 ml fibrinogen to be coagulated with 2 ml of thrombin. The glue had a fibrinogen concentration of approximately 12 times the value in platelet rich plasma and the concentration of growth factors was approximately eight times the value in platelet rich plasma. We have used this glue successfully with particulate bone grafts for reconstructive purposes within the oral and maxillofacial field. It might as well be applied to other surgical areas. Whenever larger amount of the glue will be needed, a whole unit of blood may be taken from the patient, and the red cells re-transfused to the patient during or after the operation.

Fibrin glue in pulmonary resection: a prospective, randomized, blinded study

BACKGROUND

In contrast to the rare large-airway bronchopleural fistulas after lung resection, peripheral or alveolar air leaks (AAL) are very common, often prolong hospital stay, increase utilization of resources, and on occasion result in significant morbidity. Various adjuncts have been used in attempts to reduce AAL. One of these, the topical application of fibrin glue, has to date failed to demonstrate efficacy in small clinical trials. This study reexamines the role of fibrin glue in routine lobar and wedge pulmonary resections.

METHODS

Of 113 patients enrolled, 13 became ineligible because of intraoperative findings. The remaining 100 patients were randomly assigned to one of two groups at the conclusion of lung resection, regardless of the presence or absence of identifiable air leak. The control group received no additional intervention. The experimental group underwent application of 5 mL of fibrin glue delivered by a pressurized, aerosolized spraying mechanism. Postoperatively a blinded clinical observer recorded outcomes including the incidence and duration of AAL, prolonged AAL (PAAL), the volume of pleural drainage, the time to tube removal, and the postoperative length of stay (LOS), as well as any complications related to treatment.

RESULTS

Both groups were comparable with regard to demographics, diagnoses, and procedures. Statistically significant reductions were found in the experimental group in the overall incidence of AAL (34% versus 68%, p = 0.001), mean duration of AAL (1.1 versus 3.1 days, p = 0.005), mean time to chest tube removal (3.5 versus 5.0 days, p = 0.02), and the incidence of PAAL (2% versus 16%, p = 0.015). There was no significant difference in the volume of chest tube drainage or LOS (4.6 days glue and 4.9 days control, p = 0.318). There were no complications related to the use of fibrin glue.

CONCLUSIONS

Aerosolized fibrin glue appears to be safe and effective in reducing AAL. The overall incidence of AAL was reduced by 50% and PAAL occurred in only 1 treated patient (2% versus the usually reported 15%). Further studies with this and other methods are required to delineate routine versus selective use, to compare methods, and clarify cost benefit.

Cauterization versus fibrin glue for aerostasis in precision resections for secondary lung tumors

BACKGROUND

Aerostasis control in multiple resections for metastatic pulmonary diseases is a real problem. Long-term air leaks prolong postoperative hospitalization and result in an additional financial burden on the healthcare system. We focused our study on the evaluation of fibrin glue (Tissucol) as an effective means to minimize or prevent air leaks.

METHODS

We initiated a case-control study whereby 100 patients underwent precision resections for lung metastases. The subjects were divided into 2 groups, both with 50 patients: group 1 was treated with fibrin glue and group 2 with cauterization. Evaluation parameters consisted of the following: air leak duration, expected complications, drain time, and in-hospital stay.

RESULTS

In group 1, air-leak time was 2.68 +/- 1.72 days, versus 7.80 +/- 8.52 for group 2 (P <.001). In group 1, there were 2% complications, whereas in group 2 there were 28% (P <.001). Drain time was 4.54 +/- 1.83 days for group 1 and 9.54 +/- 8.35 for group 2 (P <.001). In-hospital stay was 6.54 +/- 1.83 days for group 1 and 11.54 +/- 8.35 for group 2 (P <.001).

CONCLUSIONS

In the group treated with fibrin glue, we observed significant advantages. Our experience shows that the use of fibrin glue can improve aerostasis control in nonanatomical resections with high risk of air leak.

Intraoperative techniques to prevent air leaks

Persistent air leaks prolong chest tube duration and hospital stay after lung surgery. Air leaks also may lead to life-threatening empyemas. Preventing postoperative air leaks and BPFs is the best treatment for air-leak complications. Meticulous closure of parenchymal, pleural, and bronchial defects is the mainstay of air-leak control. The reinforcement of parenchymal suture and staple lines, pleural apposition, and well-vascularized tissue-flap coverage of bronchial suture and staple lines further reduce the incidence of prolonged air leaks and BPFs.

Concentrated autologous plasma protein: a biochemically neutral solder for tissue welding

BACKGROUND AND OBJECTIVE

Xenographic or allographic serum protein solders used for laser welding may have immunologic and/or pathogenic complications. The objective of these studies was to develop a safe, autologous solder.

STUDY DESIGN/MATERIALS AND METHODS

Five methods of preparing concentrated autologous plasma protein solder (CAPPS) were evaluated. Next, the CAPPS was evaluated via (1) thermal denaturation studies using differential scanning calorimetry, (2) tissue welding studies to characterize both acute and healing properties.

RESULTS

The optimal concentration method to produce CAPPS rapidly was a dialysis method using chemical (osmotic) forces. The CAPPS showed similar denaturation profiles to serum albumin (SA) solders. Acutely, CAPPS provided comparable breaking strengths to SA solders. At 7 days, there was no significant difference in breaking strength or histology between 50% human SA solder and CAPPS (using a porcine skin model).

CONCLUSIONS

These studies demonstrate that the CAPPS system provides acceptable acute and chronic properties for laser welding.

Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair

OBJECTIVE

To evaluate the efficacy of mesh fixation with fibrin sealant (FS) in laparoscopic preperitoneal inguinal hernia repair and to compare it with stapled fixation.

SUMMARY BACKGROUND DATA

Laparoscopic hernia repair involves the fixation of the prosthetic mesh in the preperitoneal space with staples to avoid displacement leading to recurrence. The use of staples is associated with a small but significant number of complications, mainly nerve injury and hematomas. FS (Tisseel) is a biodegradable adhesive obtained by a combination of human-derived fibrinogen and thrombin, duplicating the last step of the coagulation cascade. It can be used as an alternative method of fixation.

METHODS

A prosthetic mesh was placed laparoscopically into the preperitoneal space in both groins in 25 female pigs and fixed with either FS or staples or left without fixation. The method of fixation was chosen by randomization. The pigs were killed after 12 days to assess early graft incorporation. The following outcome measures were evaluated: macroscopic findings, including graft alignment and motion, tensile strength between the grafts and surrounding tissues, and histologic findings (fibrous reaction and inflammatory response).

RESULTS

The procedures were completed laparoscopically in 49 sites. Eighteen grafts were fixed with FS and 16 with staples; 15 were not fixed. There was no significant difference in graft motion between the FS and stapled groups, but the nonfixed mesh had significantly more graft motion than in either of the fixed groups. There was no significant difference in median tensile strength between the FS and stapled groups. The tensile strength in the nonfixed group was significantly lower than the other two groups. FS triggered a significantly stronger fibrous reaction and inflammatory response than in the stapled and control groups. No infection related to method of fixation was observed in any group.

CONCLUSION

An adequate mesh fixation in the extraperitoneal inguinal area can be accomplished using FS. This method is mechanically equivalent to the fixation achieved by staples and superior to nonfixed grafts. Biologic soft fixation with FS will prevent early graft migration and will avoid the complications associated with staple use.

Experimental study on the in vivo behaviour of a new collagen glue in lung surgery

OBJECTIVE

To study the pneumostatic ability of a collagen polymerised with a polysaccharide (GAO) glue in lung surgery; its influence in pleuro-pulmonary adhesion formation; the pulmonary tissue reaction to it, its biodegradability, and the eventual alterations of pulmonary compliance induced by the glue.

METHODS

Two groups of ten rabbits (controls and treated) were operated under ventilatory assistance by thoracotomy to promote pleural adhesions, and injury to the lung. Repeated chest X-rays were carried out postoperatively. Lungs were examined histologically at day 40. In vitro tests were performed to study glue effects on pulmonary compliance.

RESULTS

Air leaks stopped 2 min after glue application. Persistent pneumothorax were likely seen in treated rabbits (ns). Glue induces a temporary reduction of pulmonary compliance. Glue did not increase adhesion formation, or interfere with the healing process.

CONCLUSIONS

For its properties, GAO seems to be a good and well-tolerated tool to reduce air leaks from the lung, without inducing residual pleural symphysis.

Effect of fibrin glue in the reduction of postthoracotomy alveolar air leak

BACKGROUND

Intraoperative use of fibrin glue has been advocated in reducing postthoracotomy alveolar air leak, although most studies have not been randomized and have focused on its routine use after lung resection.

METHOD

This study specifically addresses the effectiveness of fibrin glue in reducing alveolar air leak only in patients considered intraoperatively to have continued moderate to severe alveolar air leak after all conventional measures to reduce it have been used.

RESULTS

During a 24-month period, 66 patients undergoing lobectomies, segmentectomies, or decortication were randomized either to serve as controls (n = 33) or to have fibrin glue sprayed on the "raw" lung surface (n = 33). The median duration of intercostal drainage and in-hospital stay was 6 and 9 days, respectively, in the control group and 6 and 8 days, respectively, when fibrin glue was used. Statistical analysis revealed no differences between the groups.

CONCLUSION

Fibrin glue does not add to conventional techniques in reducing moderate to severe alveolar air leak after thoracic operations.

The role of sutures and fibrin sealant in wound healing

Sutures and fibrin sealant are important surgical aids for facilitating wound closure and creating an optimal setting for wound healing. Most commonly, sutures are used to close wounds because suture material provides the mechanical support necessary to sustain closure. A wide variety of suturing material is available, and the surgeon can choose among sutures with a range of attributes to find the one best suited to his or her needs. Considerations when choosing an appropriate suture for wound closure and healing include strength of suture, holding power of tissue, absorbability, risk of infection, and inflammatory reaction associated with the suture material. Other factors to be considered include type of incision, suturing technique, and appearance of wound site. Fibrin sealant, in contrast, is a biologic tissue adhesive that can function as a useful adjunct to sutures. Fibrin sealant can be used in conjunction with sutures or tape to promote optimal wound integrity, or it can be used independently to seal wound sites where sutures cannot control bleeding or would aggravate bleeding. This adhesive can effectively seal tissue planes and eliminate potential spaces. Fibrin sealant has been used clinically in many surgical applications, although an FDA-approved commercially available product does not yet exist in the United States. Clinically, fibrin sealant has resulted in a low rate of infection and has promoted healing. Further study is needed to determine the best fibrin sealant mixtures both to achieve hemostasis and to encourage healing. It may even be desirable to use different sealant formulations for particular clinical situations.

Preparation of autologous fibrin glue from pericardial blood

To salvage patients' blood and improve hemostasis in cardiac operations, autologous fibrin glue was prepared in a new way by means of ethanol from pericardial blood. The yield from 44 mL of blood was 2.1 +/- 0.7 mL (mean +/- standard deviation) of fibrinogen concentrate with a concentration of 25.1 +/- 7.5 mg/mL; 2.7 mL of two-component glue was obtained after the addition of thrombin solution. The glue has the advantages of safety from transmission of viral diseases and from immunologic reactions.