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Gocoł R, Bis J, Hudziak D, Morkisz Ł, Deja MA. Aortic Root Reconstruction with TachoSil Fibrin Sealant Patch in Acute Type A Aortic Dissection. Ann Thorac Cardiovasc Surg 2021; 27:267-272. [PMID: 33563845 PMCID: PMC8374091 DOI: 10.5761/atcs.nm.20-00198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: We propose a novel technique for reconstruction of the dissected aortic root with the use of TachoSil fibrin sealant patch. Methods: Patients with acute type A aortic dissection involving the aortic root were included. Appropriately prepared TachoSil fibrin sealant patch was placed between the dissected layers of the aortic root to achieve their durable fusion. Thus, the false lumen was eliminated, and the anatomical and functional structure of the aortic wall was restored. Results: In all, 13 patients mean aged 57 ± 10.3 years underwent surgery for acute type A aortic dissection with the use of TachoSil fibrin sealant patch. All patients survived the surgery. The mean follow-up time was 30.8 ± 16.4 months. Follow-up computed tomography angiography (CTA) scans confirmed no aortic root dissection in all patients. Conclusions: This technique ensures durable restoration of the aortic wall structure, eliminates the secondary aortic valve regurgitation, and allows for the preservation of patients’ native aortic valve.
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Affiliation(s)
- Radosław Gocoł
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Jarosław Bis
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Łukasz Morkisz
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Marek A Deja
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
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Ohno N, Maeda T, Kato O, Sato H, Ueno G, Yoshizawa K. Neomedia Repair of the Valsalva Sinus in the Treatment of Acute Type-A Aortic Dissection: Long-term Effectiveness and a Case of Pathology. Ann Vasc Dis 2020; 13:248-254. [PMID: 33384726 PMCID: PMC7751080 DOI: 10.3400/avd.oa.20-00113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although numerous surgical techniques are employed to treat acute Stanford type A aortic dissection (ATAAD), controversy remains over which is the best procedure for aortic root reconstruction. Among the various techniques utilized, neomedia repair is considered to be more promising than adhesive-only repair for the treatment of a dissected aortic root. We experienced a series of neomedia sinus Valsalva repair using woven polyester fabric, and evaluated the aortic root diameter by computed tomography and severity of aortic valve insufficiency by transthoracic echocardiography. The aortic root diameter was well preserved with no progress of aortic valve insufficiency in the long-term period. Furthermore, we found that the fabric looked functioning new media in the findings obtained from the pathological examination of a neomedia repaired aortic wall sample that was obtained by chance from a patient during valve replacement surgery performed 10 years after aortic reconstruction for ATAAD. Neomedia repair using woven polyester fabric for ATAAD might facilitate the long-term durability of the surgically treated aortic root. (This is a translation of J Jpn Coll Angiol 2019; 59: 37–43.)
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Affiliation(s)
- Nobuhisa Ohno
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Toshi Maeda
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Otohime Kato
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Hirofumi Sato
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Go Ueno
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Kosuke Yoshizawa
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
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Komarov RN, Karavaĭkin PA, Kuznetsov AA, Shcherbenev VM, Bredikhin RA, Gnevashev AS, Iudin AN, Tsekhanovich VN, Andreev DB. [Use of topical haemostatic agents in cardiovascular surgery]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:131-142. [PMID: 30994619 DOI: 10.33529/angio2019118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The problem of haemostasis in cardiovascular surgery is of current concern. Recent trends are towards increased use of topical haemostatic agents. Tachocomb has been used for more than 30 years in abdominal surgery and oncology. The purpose of the present publication is to analyse the literature data and formulate the indications for the use of Tachocomb in cardiovascular surgery. Multicenter randomized and local studies have demonstrated efficacy of Tachocomb in treatment of surgical haemorrhage in operations on the heart, thoracic aorta, carotid arteries and lower-limb arteries, resulting in significantly decreased time to achieve haemostasis, decreased volume of blood loss and haemotrasfusion, as well as reduced frequency of complications. Also shown was economic efficacy, including a shortened length of patients' hospital stay. This is followed by describing a wide spectrum of examples of alternative use of Tachocomb, including its use for seamless closure of defects of cardiac chamber walls, aero- and lymphostasis, prevention of formation of commissures. Convincing experimental and clinical results make it possible to formulate a series of indications for the use of Tachocomb in cardiovascular surgery.
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Affiliation(s)
- R N Komarov
- Clinic of Aortic and Cardiovascular Surgery, Chair of Hospital Surgery of Therapeutic Department, First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia
| | - P A Karavaĭkin
- Clinic of Aortic and Cardiovascular Surgery, Chair of Hospital Surgery of Therapeutic Department, First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia
| | - A A Kuznetsov
- Central Military Clinical Hospital named after A.A. Vishnevsky of the RF Ministry of Defence, Moscow, Russia
| | | | - R A Bredikhin
- Interregional Clinical and Diagnostic Centre, Kazan, Russia
| | - A S Gnevashev
- North-West Federal Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - A N Iudin
- Ulyanovsk Regional Clinical Hospital, Ulyanovsk, Russia
| | | | - D B Andreev
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Khabarovsk, Russia
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Nenezić D, Ayguasanosa J, Menyhei G, Tamás H, Mátyás L, Muluk S, Courtney K, Ibáñez J, Chen J. A prospective, single-blind, randomized, phase III study to evaluate the safety and efficacy of Fibrin Sealant Grifols as an adjunct to hemostasis compared with manual compression in vascular surgery. J Vasc Surg 2019; 70:1642-1651. [PMID: 30926276 DOI: 10.1016/j.jvs.2018.12.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE New formulations and applications of hemostatic adjuncts such as fibrin sealant (FS) to support local hemostasis and sutures continue to be developed. In a pivotal, confirmatory, controlled, prospective, single-blinded, randomized, multicenter phase III clinical trial, the efficacy and safety of FS Grifols during vascular surgeries were evaluated. METHODS Patients undergoing a nonemergency, open, peripheral vascular surgical procedure with moderate arterial bleeding were recruited. In an initial preliminary part of the study, all patients were treated with FS Grifols. In a subsequent primary part, patients were randomized (2:1) to FS Grifols or manual compression (MC). The primary efficacy end point was the proportion of the primary part patients achieving hemostasis by 4 minutes after the start of treatment. Cumulative proportion and time to hemostasis were secondary efficacy end points. Safety end points (in pooled preliminary and primary parts) included adverse events (AEs), vital signs, physical assessments, clinical laboratory tests, viral markers, and immunogenicity. RESULTS The primary efficacy end point was met by 76.1% of patients (83/109) for the FS Grifols group versus 22.8% of patients (13/57) for the MC group (P < .001). The cumulative proportion of patients at 5, 7, and 10 minutes was 80.7%, 84.4%, and 88.1%, respectively, in the FS Grifols treatment group, and 28.1%, 35.1%, and 45.6% in the MC treatment group (P < .001). The median time to hemostasis was shorter in the FS Grifols group (4 minutes vs ≥10 minutes in the MC group; P < .001). The nature of AEs reported were those expected in the study patient profile. The percentage of patients experiencing treatment-emergent AEs were similar in both the FS Grifols (pooled n = 59 + 109) and MC groups (81.0% and 77.2%, respectively), most recurrent being procedural pain (34.5% and 36.8%, respectively) and pyrexia (11.3% and 10.5%, respectively). CONCLUSIONS FS Grifols was superior in efficacy and similar in safety to MC as an adjunct local hemostatic agent in patients undergoing open vascular surgeries.
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Affiliation(s)
- Dragoslav Nenezić
- Institute for Cardiovascular Diseases "Dedinje", Clinic for Vascular Surgery, Belgrade, Serbia.
| | | | - Gábor Menyhei
- Department of Vascular Surgery, Pecs University Clinical Center, Pecs, Hungary
| | - Holjencsik Tamás
- Department of Vascular Surgery, Csolnoky Ferenc County Hospital, Veszprem, Hungary
| | - Lajos Mátyás
- Department of Vascular and Endovascular Surgery, Borsod Teaching County Hospital Miskolc, Borsod, Hungary
| | - Satish Muluk
- Division of Vascular Surgery, Allegheny General Hospital, Pittsburgh, Pa
| | - Kecia Courtney
- Grifols Bioscience Research Group, Grifols, Barcelona, Spain
| | - Julia Ibáñez
- Grifols Bioscience Research Group, Grifols, Barcelona, Spain
| | - Junliang Chen
- Grifols Bioscience Research Group, Grifols, Barcelona, Spain
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Ohno N, Minatoya K. Reinforcement and reapproximation of the aortic stump during surgery for acute aortic dissection. Surg Today 2019; 49:645-648. [PMID: 30610362 DOI: 10.1007/s00595-018-1758-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022]
Abstract
Anastomosis of the fragile aortic wall in patients with acute aortic dissection presents a challenge to cardiovascular surgeons. Reinforcement of the stump is a key to accomplishing successful anastomosis. Surgical glues such as gelatin-resorcin-formalin (GRF) glue and Bioglue are easy to use and have radically changed the process of the reinforcement and reapproximation. However, as surgical glues have been associated with disadvantages such as tissue necrosis, enthusiasm for their use has waned. In this review, we discuss the various methods for reinforcement and reapproximation of the aortic stump during operations for acute aortic dissection, mainly outside the category of surgical glues.
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Affiliation(s)
- Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Fonouni H, Kashfi A, Majlesara A, Stahlheber O, Konstantinidis L, Kraus TW, Mehrabi A, Oweira H. Analysis of the hemostatic potential of modern topical sealants on arterial and venous anastomoses: an experimental porcine study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:134. [PMID: 28755096 DOI: 10.1007/s10856-017-5932-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
One of the widely accepted adjunctive agents in the variety of surgical modalities are sealants. Our study aim was to compare four commonly used modern sealants in a standardized experimental setting to assess their feasibility, and hemostatic efficacy in vascular anastomosis. Forty landrace pigs (weight: 24.7 ± 3.8 kg) were randomized into the control (n = 8) and four sealant groups; TachoSil® (n = 8), Tissucol Duo® (n = 8), Coseal® (n = 8), and FloSeal® (n = 8). After doing a portal vein end-to-end anastomosis as well as stitches of aortic incision, the sealants were applied on anastomotic site. The control group was left intact. In portal vein anastomosis, the sealants led to a complete hemostasis significantly better than control group. The mean of blood loss was also significantly reduced. In successful subgroups, there was a difference in the mean-time to reach complete hemostasis ranging from 15 s in Coseal® to 76 s in FloSeal® group (p < 0.05). In aortotomy experiments, except Tissucol Due®, which had insufficient hemostasis, other sealants led to a complete hemostasis. The mean blood loss was significantly reduced in sealants groups as well. The four sealants are effective in reducing the suture-hole bleeding in portal vein anastomosis. However, the hemostatic potential is heterogeneous among sealants. This means that "one-size-fits-all" approach is not appropriate for application of sealants in diversity of vascular surgery and it should be based on the type and the severity of injury and the structure of tissue. Comparison of hemostasis efficacy of four modern sealants (TachoSil®, Tissucol Duo®, Coseal®, and FloSeal®) in vascular anastomosis in porcine model. The figures below show the total blood loss (g) in the control and sealant groups after aortotomy (left) and portal vein anastomosis (right). The mean of blood loss decreased significantly by the usage of sealants in both experiment groups as compared to control group (*: p < 0.05; sealant groups vs. control group). 1. The right column shows the mean of blood loss (g) in all experiments in each group. 2. The middle column presents the subgroup with unsuccessful hemostasis at the end of observation time (Tmax = 20 sec. for aortotmy and 300 sec. for portal vein anastomosis). 3. The left column shows mean of total blood loss in subgroups with successful hemostasis during observation time (20 sec for aortotomy and 300 sec for portal vein).
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Affiliation(s)
- Hamidreza Fonouni
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arash Kashfi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Oliver Stahlheber
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lukas Konstantinidis
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas W Kraus
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Hani Oweira
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Ohira S, Fukumoto A, Matsushiro T, Yaku H. Novel Technique Using Polyester Fabric and Fibrin Sealant Patch for Acute Aortic Dissection. Heart Lung Circ 2016; 25:885-7. [PMID: 27011040 DOI: 10.1016/j.hlc.2016.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 11/17/2022]
Abstract
We describe a simple and effective technique for acute aortic dissection using a combination of polyester fabric and a fibrin sealant patch (FSP) to achieve effective reinforcement and haemostasis of the aortic stump. Firstly, the 0.61mm thick knitted polyester fabric sheet was cut to half of the size of the FSP. Next, fibrin glue was sprayed onto the collagen layer of the FSP. Subsequently, a fabric sheet was placed upon it, and the FSP was put together with the irrigated collagen layer, and then completely dried to bind the patch. As a result, the dry fibrinogen/thrombin layers, as an adhesive surface, faced outward. This patch was trimmed to a 10-15-mm-wide strip. The composite patch was inserted into the false lumen. The stump was gently pressed to fix the aortic intima and adventitia. There are several advantages: the combined patch can be prepared during systemic cooling, and therefore can minimise the circulatory arrest time; secondly, the false lumen is not directly exposed to fibrin glue and so the risk of embolism is extremely low; thirdly, the expected haemostatic effect is greater as FSP lines the exterior of the intima, achieving haemostasis for suture holes.
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Affiliation(s)
- Suguru Ohira
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Atsushi Fukumoto
- Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Takuya Matsushiro
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Blutkompatibler und adhäsionsstarker Gewebekleber. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00398-015-0015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ohira S, Watanabe T, Yaku H. Layered wrapping technique combined with oxidized cellulose and vascular prosthesis for effective haemostasis in aortic surgery. Interact Cardiovasc Thorac Surg 2014; 20:276-7. [PMID: 25415316 DOI: 10.1093/icvts/ivu396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bleeding from anastomotic sites is one of the major complications of aortic surgery. We describe a novel double-layer wrapping technique using a combination of oxidized cellulose and a vascular prosthesis to effectively achieve haemostasis. The anastomotic site is surrounded by a prosthetic graft inlaid with a strip of Nu-Knit. These are fixed by horizontal mattress and over-and-over sutures. Nu-Knit acts as an ideal cushion to achieve haemostasis, because it has a haemostatic effect and fills the space between the anastomotic site and wrapping graft. This technique is simple, and facilitates adequate haemostasis without complications.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taiji Watanabe
- Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Hutter G, von Felten S, Sailer MH, Schulz M, Mariani L. Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial. J Neurosurg 2014; 121:735-44. [PMID: 25036199 DOI: 10.3171/2014.6.jns131917] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cerebrospinal fluid leakage is an immanent risk of cranial surgery with dural opening. Recognizing the risk factors for this complication and improving the technique of dural closure may reduce the associated morbidity and its surgical burden. The aim of this paper was to investigate whether the addition of TachoSil on top of the dural suture reduces postoperative CSF leakage compared with dural suturing alone and to assess the frequency and risk factors for dural leakage and potentially related complications after elective craniotomy. METHODS The authors conducted a prospective, randomized, double-blinded single-center trial in patients undergoing elective craniotomy with dural opening. They compared their standard dural closure by running suture alone (with the use of a dural patch if needed) to the same closure with the addition of TachoSil on top of the suture. The primary end point was the incidence of CSF leakage, defined as CSF collection or any open CSF fistula within 30 days. Secondary end points were the incidence of infection, surgical revision, and length of stay in the intensive care unit (ICU) or intermediate care (IMC) unit. The site of craniotomy, a history of diabetes mellitus, a diagnosis of meningioma, the intraoperative need of a suturable dural substitute, and blood parameters were assessed as potential risk factors for CSF leakage. RESULTS The authors enrolled 241 patients, of whom 229 were included in the analysis. Cerebrospinal fluid leakage, mostly self-limiting subgaleal collections, occurred in 13.5% of patients. Invasive treatment was performed in 8 patients (3.5%) (subgaleal puncture in 6, lumbar drainage in 1, and surgical revision in 1 patient). Diabetes mellitus, a higher preoperative level of C-reactive protein (CRP), and the intraoperative need for a dural patch were positively associated with the occurrence of the primary end point (p = 0.014, 0.01, and 0.049, respectively). Cerebrospinal fluid leakage (9.7% vs 17.2%, OR 0.53 [95% CI 0.23-1.15], p = 0.108) and infection (OR 0.18 [95% CI 0.01-1.18], p = 0.077) occurred less frequently in the study group than in the control group. TachoSil significantly reduced the probability of staying in the IMC unit for 1 day or longer (OR 0.53 [95% CI 0.27-0.99], p = 0.048). Postoperative epidural hematoma and empyema occurred in the control group but not in the study group. CONCLUSIONS Dural leakage after elective craniotomy/durotomy occurs more frequently in association with diabetes mellitus, elevated preoperative CRP levels, and the intraoperative need of a dural patch. This randomized controlled trial showed no statistically significant reduction of postoperative CSF leakage and surgical site infections upon addition of TachoSil on the dural suture, but there was a significant reduction in the length of stay in the IMC unit. Dural augmentation with TachoSil was safe and not related to adverse events. Clinical trial registration no. NCT00999999 ( http://www.ClinicalTrials.gov ).
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