Reduction of Perioperative Hemorrhage by Anterior Mediastinal Spray Application of Fibrin Glue During Cardiac Reoperations

Abstract

A severe problem associated with repeat cardiac surgery is postoperative bleeding, conditioned mainly by the cardiopulmonary bypass and its duration, systemic heparinization, and the existence of cardiopericardial adhesions derived from earlier operations. Of the numerous methods employed to reduce the amount of postoperative hemorrhage, one involves the use of fibrin glue. To assess the effectiveness of fibrin sealing on postoperative bleeding in cardiac reoperation, we used the human fibrinogen concentrate Tisseel in spray form in the areas of cardiopericardial detachment from anterior mediastinum, prior to closing the median sternotomy. We measured the blood losses via the chest tubes in the first 48 h. We studied three groups of patients with similar characteristics in terms of cardiac pathology, myocardial ischemia, and extracorporeal circulation (ECC) times, type of myocardial protection, degree of hypothermia, dose and control of heparin and protamine sulfate, and surgeons involved in the procedure. Tube drainage was controlled postoperatively at 2, 6, 12, 24, 36, and 48 h. Group A included patients who underwent open-heart surgery with ECC for the first time; group B, patients undergoing repeat operation with ECC in whom the spray sealant was applied prior to sternotomy closure; and group C, as group B but without fibrin sealant. According to the Student’s t test, the differences between groups A and B and between B and. C with respect to chest drainage were statistically significant at all the time points of the study (p < 0.001). This method may reduce postoperative mediastinal hemorrhage following cardiac reoperation.