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J Thorac Cardiovasc Surg 2005;129:18-24
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Three-layered synthetic pericardial substitutes reduce postoperative pericardial adhesions

^a Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,
^b Ube Industry Ltd, Ichihara, Japan

Received for publication October 30, 2003; revisions received February 23, 2004; revisions received March 8, 2004; accepted for publication March 16, 2004.

^* Address for reprints: Shigeki Morita, MD, Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
morita{at}heart.med.kyushu-u.ac.jp

BACKGROUND: The development of postoperative pericardial adhesions increases the risk of cardiac reoperations. The purpose of this study was to test a new pericardial substitute (UBE sheet; UBE Industries, Ltd, Tokyo, Japan) that consists of 3 layers, namely, a middle layer of polyester inserted between 2 layers of silicone-urethane copolymer.

METHODS: Before implantation into the animals, platelet adhesion to the UBE sheet was evaluated in vitro. In the canine model, the UBE sheet (group I; n = 6) was implanted for 3 months. The development of adhesions, epicardial reactions, the shrink ratio of the patch, and macrophage infiltration to the epicardium with histologic examination were evaluated. As a control, an expanded polytetrafluoroethylene sheet (group II; n = 5) was implanted in the same manner.

RESULTS: Scanning electron microscopy of the platelets adhered to the sheet showed that the UBE sheet was superior in biocompatibility compared with the expanded polytetrafluoroethylene sheet. In the canine study, group I showed fewer adhesions than group II (median [25th percentile, 75th percentile]: 0.0 [0.0, 0.0] vs 1.0 [1.0, 2.3]; P = .003; Mann-Whitney U test), fewer epicardial reactions (1.75 [1.0, 3.0] vs 3.0 [3.0, 3.0]; P = .034), and a smaller shrink ratio (8.0% [5.5%, 12.4%] vs 31.7% [30.0%, 44.8%]; P = .006). Immunohistologic studies showed fewer macrophage infiltrations (86 [56.8, 139.3] vs 201 [161.0, 276.5] in 3 fields; P = .045) into the epicardium of group I.

CONCLUSIONS: The new 3-layered pericardial substitute clearly reduced adhesion formation. We concluded that this sheet may cause fewer adhesions and a less severe inflammatory reaction after cardiac surgery, thereby facilitating safe adhesiolysis reoperation.

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