Enhanced hemostasis with a sealant consisting of Hydrofit and Surgicel

Clinical Outcome of the Type A Acute Aortic Dissection Repair Using the "Tailored Stand-Up Collar" Technique

PURPOSE

Achieving a secure anastomosis and complete hemostasis is essential for surgically treating type A acute aortic dissection (TAAAD). This study assessed the clinical feasibility of "tailored stand-up collar (TSC)" technique for constructing the distal stump.

METHODS

We enrolled 68 patients who underwent ascending aortic repair for TAAAD. Patients were categorized according to the technique for distal stump construction: conventional (C) group using only a felt strip (32 cases); post-aortotomy (P) group, with a Hydrofit-felt strip attached after aortotomy (18 cases), and TSC group, where a Hydrofit-felt strip attached during cooling (18 cases). Pre-operative characteristics, procedural profiles, and post-operative outcomes were evaluated.

RESULTS

The pre-operative characteristics were identical among the groups. The durations of cardiopulmonary bypass, hemostasis, and surgery were significantly shorter in the P and TSC groups. The duration of open distal in the TSC group (21 min) was significantly shorter than the other two groups. Post-operative additional procedures were not required for the TSC group and their post-operative hospital stay was significantly shorter (47.1% of patients were discharged within 2 weeks).

CONCLUSION

The TSC technique would be practical because of its high reproducibility in terms of ease of use, shorter anastomotic time, and secure hemostasis.

Hemostatic capability of a novel tetra-polyethylene glycol hydrogel

OBJECTIVES

TetraStat is a tetra-armed polyethylene glycol (PEG) hydrogel. It is a synthetic sealant that solidifies instantly in response to pH changes. This study aimed to evaluate the hemostatic effect of TetraStat through experiments evaluating future clinical applications.

METHODS

We used TetraStat, oxidized regenerated cellulose (SURGICEL®), and fibrinogen and thrombin sealant patch (TachoSil®) using in vitro and in vivo experiments. For the in vitro experiment, a closed circulatory system filled with phosphate-buffered saline under high pressure was used. Needle punctures were created and closed using the various sealants. For the in vivo experiment, rat venae cavae were punctured with 18- and 20-gauge (G) needles, and hemorrhage was allowed to occur for several seconds. A porous PEG sponge soaked with TetraStat was applied as a hemostatic system. Hemostasis outcomes were compared among the various concentrations (40-100 g/L) of TetraStat, SURGICEL, and TachoSil.

RESULTS

The punctured holes in the prosthetic graft were successfully sealed with TetraStat in 1 min. The success rate of hemostasis with TetraStat for the punctured holes in the rat vena cava was dose-dependent. TetraStat was effective in sealing the holes created with a 20 G needle at all concentrations; however, the holes created with an 18 G needle could be sealed only when the concentration ≥60 g/L. Hemostasis using SURGICEL or TachoSil was less successful and sometimes required up to 5 min.

CONCLUSIONS

TetraStat has a high hemostatic ability. A porous PEG sponge soaked with TetraStat is a useful choice for effective hemostasis during massive hemorrhage.

New hemostatic technique with combined use of Hydrofit® and Surgicel®: an in vitro and in vivo study

We developed an effective hemostatic technique using Hydrofit^® and Surgicel^® simultaneously. The aim of this study was to demonstrate the hemostatic efficacy of the Hydrofit^® and Surgicel^® combination technique through an in vitro experiment and to elucidate mid-term consequences of the combined components through an in vivo experiment. For the in vitro experiment, a closed circuit using a heparin-coated cardiopulmonary bypass circuit and a prosthetic graft was created. The amount of bleeding from the prosthetic graft was measured, and the following three hemostatic methods were applied: only gauze compression in control group, Hydrofit^® application in Hydrofit group, Surgicel^® spread Hydrofit^® application in Hydrofit and Surgicel (HS) group, respectively. In the in vivo experiment, Hydrofit^® and/or Surgicel^® were implanted under skin on the back of rats (n = 10) at 4 points. In the control group, only an incision was made; in the Hydrofit, Surgicel, and HS groups, Hydrofit^® and/or Surgicel^® was implanted. One and three months later, each of the five rats were killed and in each section histopathologic examination was carried out. In the in vitro experiment, the amount of bleeding was 7.84 ± 1.08, 2.26 ± 1.02, and 0.87 ± 0.38 ml in the control, Hydrofit, and HS groups, respectively. The amount of bleeding in the HS group was more suppressed than in the Hydrofit group (p = 0.012). In the in vivo experiment, the maximal depth diameter of each remaining hemostatic sealant was measured. After 3 months, the diameter was 0, 2289.0 ± 768.2, 3850.3 ± 935.8 μm in Surgicel, Hydrofit and HS groups, respectively. The diameter was significantly increased in the HS group compared with the Surgicel and Hydrofit groups (p < 0.001, respectively,). In conclusion, the combination of Hydrofit^® and Surgicel^® was effective in achieving hemostasis. The remnants of Hydrofit^® and Surgicel^® were present for a long time in the tissues which could compress the surrounding tissue.

Sutureless hemostasis of a coronary sinus rupture with Hydrofit

Coronary sinus rupture (CSR) is a rare operative complication, and a standard procedure for its treatment has not been established. We report successful repair of a CSR in a 68-year-old man who underwent total arch replacement for type A acute aortic dissection. CSR was caused by the coronary sinus cannulation for retrograde cardioplegia and was detected during cardiopulmonary bypass weaning. We applied an elastomeric sealant with a bovine pericardium patch on the beating heart. After manual compression for 2 min, complete hemostasis was achieved. A clampless and sutureless hemostasis for repairing coronary sinus rupture is a simple, fast, and effective technique.

Oxidized cellulose-based hemostatic materials

The application of hemostatic agents is essential to prevent significant blood loss and death from excessive bleeding in surgical or emergency scenarios. Oxidized cellulose is an excellent biodegradable and biocompatible derivate of cellulose, which has become one of the most important hemostatic agents used in surgical procedures. However, to date, there has been no comprehensive report assessing oxidized cellulose-based hemostatic materials. Hence, this paper first reviewed the oxidation preparation, cellulose origin and structure, as well as biodegradability and safety of oxidized cellulose. Then a comprehensive review regarding the hemostatic mechanisms, various forms, modification, and current commercially available products of oxidized cellulose is discussed, which emphatically presents the most significant developments in the recent scientific literature. In conclusion, this paper summarizes the latest developments in oxidized cellulose-based hemostatic materials and provides a reference for further research and development in this field.

Potential utility of new surgical hemostatic film using Hydrofit®: a preliminary study

We developed a surgical hemostatic film using Hydrofit^® (Hydrofit^® film). This film is prepared by reacting Hydrofit^® with water in advance, and it can be used in the same way as an accessory silicone sheet. In addition, unlike the silicone sheet, there is no need to remove the Hydrofit^® film from the body. In the present study, we describe the hemostatic effect of our new method using Hydrofit^® film. We created a pulsatile flow circuit model using a ventricular assist device and a vascular graft. The circuit was filled with water, and the systolic pressure was adjusted to ≥ 130 mmHg. The artificial blood vessel was punctured by an 18-G needle. Operations to prevent water from leaking were attempted through either a conventional method using a silicone sheet or our new method using Hydrofit^® film. In the 180-s trial, 14 attempts (93.3%) with the Hydrofit^® film were successful. In the silicone sheet group, 13 attempts (86.7%) were successful before the silicone sheet was peeled off, and hemostasis was maintained in 10 (66.5%) cases after the silicone sheet was removed. After short-duration hemostasis for 60 s, good waterproofing was obtained in the Hydrofit^® film group (success in 17 cases [85%]). In contrast, in the silicone sheet group, 10 attempts (50%) were successful before the silicone sheet was peeled off, and hemostasis was maintained in only 7 (35%) cases after the silicone sheet was removed. Hydrofit^® film showed good hemostatic performance in the pulsatile flow circuit model.