Is Seprafilm valuable in infant cardiac redo procedures?
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RESEARCH ARTICLE
Open Access
Is Seprafilm valuable in infant cardiac redo procedures? Bruno Lefort1,2*, Jean-Marc El Arid1, Anne-Lorraine Bouquiaux1, Nathalie Soulé1, Julie Chantreuil1, Elsa Tavernier1,3, Alain Chantepie1,2 and Paul Neville1
Abstract Background: Morbidity and mortality are higher for cardiac reoperations than first operation due to the presence of post-operative adhesions. We retrospectively evaluated the efficacy of the bioresorbable membrane Seprafilm® to prevent pericardial adhesions after cardiac surgery in a paediatric congenital heart disease population. Methods: Seventy-one children undergoing reoperations with sternotomy redo and cardiopulmonary bypass for congenital malformations were included. Twenty-nine of these patients were reoperated after previous application of Seprafilm® (treatment group). The duration of dissection, aortic cross clamping and total surgery were recorded. A tenacity score was established for each intervention from the surgeon’s description in the operating report. Results: In multivariate analysis, the duration of dissection and the tenacity score were lower in the treatment than control group (p < 0.01), independent of age and interval since preceding surgery. Conclusion: Our results suggest that Seprafilm® is effective in reducing the post-operative adhesions associated with infant cardiac surgery. We recommend the use of Seprafilm® in paediatric cardiac surgery when staged surgical interventions are necessary. Keywords: Congenital heart disease, Cardiac reoperation, Tissue adhesives, Biomaterials
Background Many children with congenital heart disease require several surgical interventions to achieve correction or palliation. The opening of the pericardial cavity during each operation promotes the formation of postoperative intra-pericardial adhesions. These adhesions complicate reoperation and potentially lead to injury of cardiac structures; consequently, cardiac reoperation is associated with greater morbidity and mortality [1-3]. Moreover, adhesions can lead to dissection being very stressful and time-consuming for surgeons, even before cardiac repair has been started. Some potentially useful methods to reduce adhesions are now available for clinical use. Obviously, minimally invasive primary operations, perfect haemostasis, drainage of shed blood and clots, and direct closure of the autologous pericardium when possible, are all desirable and minimise adhesion; also the application of an adhesion * Correspondence: [email protected] 1 Children Hospital Gatien de Clocheville, Tours, France 2 University François Rabelais, Tours, France Full list of author information is available at the end of the article
barrier may help prevent adhesive processes and simplify access during subsequent interventions [4]. In our child cardiac surgery unit, we routinely apply a bioresorbable membrane, Seprafilm®, to the dry mediastinum just before sternal closure if reoperation is likely, to facilitate the future dissection. Here, we report a retrospective evaluation
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