Use of Fibrin Glue (Tissucol/Tisseel) to Achieve Hemostasis in Patches and Suture Lines in Surgical Repair of Congenital Heart Defects

Abstract

In our first study in 1983 [11], we presented our experience using Tissucol, a fibrin glue, to achieve local hemostasis in 21 patients who underwent surgical repair of tetralogy of Fallot and 10 patients who underwent a Senning operation for transportation of the great arteries (group 1). Postoperative blood loss during the first 24 h in these patients was compared with that of 20 patients with tetralogy of Fallot and 10 with transposition of the great arteries who had undergone the same operation without fibrin glue 1 year earlier (control group). No differences with respect to age, sex, body weight, preoperative coagulation status, and operative management were demonstrable between the two groups. After a marked reduction of postoperative blood loss through the application of fibrin glue was demonstrated in this first study, the results obtained using fibrin glue to achieve local hemostasis during surgery in 52 other patients (36 with tetralogy of Fallot, 16 with transposition of the great arteries; group 2) were added.

Blood loss with fibrin glue 2 h after surgery was 1.4 ml/h/kg BW in the group 2 patients with tetralogy of Fallot or transposition of the great arteries, whereas it was 4.2 ml/h/kg BW in those with tetralogy of Fallot (P < 0.01) and 4.5 ml/h/kg BW in those with transposition of the great arteries (P < 0.005) in the control group. The difference 6 h after surgery was also significant (P < 0.01): 0.9 compared with 2.2 ml/h/kg BW after surgical repair of tetralogy of Fallot and 1.2 compared with 2.5 ml/ h/kg BW after the Senning operation for transposition of the great arteries. In the ensuing 18 h, the quantity of blood lost from chest drains was approximately the same in both groups. In contrast to the first study, total blood loss during the first 24 h was also significantly lower in group 2 than in the control group (P < 0.01).

In the meantime, the rethoracotomy rate for postoperative bleeding has been reduced.

Fibrin glue reduced postoperative blood loss after intracardiac repair of tetralogy of Fallot and the Senning operation for transportation of the great arteries by securing local hemostasis in patches and suture lines. Moreover, the general reduction of postoperative bleeding leads to better identification of bleeding complications requiring reoperation. The overall rate of these complications, however, was lowered.