The Use of Fibrin Glue in Thoracic Organ Transplantation: Analysis of 4-Year Experience

Abstract

From November 1985 to May 1992, 261 heart (247 orthotopic, 7 heterotopic) and 11 heart-lung transplantations were performed in our institution. In the first 116 cases of heart transplantation (group A) the operations were carried out without the use of fibrin glue (FG), while in the last 145 cases (group B) a protocol of FG application was introduced. FG was also used in all patients who underwent heart-lung transplantation (group C). The protocol for FG application in heart transplantation requires: preparation of 5 cc FG (Tissucol) at the beginning of the operation, sealing of the atrial pulmonary artery and aortic sutures leaving the operative field dry for 4 min before aortic cross-clamp removal. In the case of reoperation 2 cc FG is sprayed onto the pericardial surfaces. In heart-lung transplantation, after thorough hemostasis of the posterior mediastinum, 5 cc FG is sprayed over mediastinic and pleural surfaces keeping the patient in circulatory arrest for 5 min at 25 °C body temperature. After completion of the tracheal anastomosis FG is applied to the suture line. No wrapping techniques are used. Right atrial and aortic anastomoses are sealed as in HTx. In all patients after protamine administration the blood is collected from the field and processed by a cell-saver. In group A 250 ± 70 ml and in group B 55 ml ± 25 ml packed red cells (hematocrit 55%) per patient were obtained from the field (p < 0.001). The time required to complete the operation after protamine administration was 85 ± 15 and 30 ± 12 min in groups A and B, respectively (p < 0.001). No significant difference was observed in postoperative bleeding concerning the need for reoperation [four cases (3.5%) in group A and three cases (1.4%) in group B]. In group C the amount of packed red cells collected during the operation (before heparinization and after protamine administration) varied from 225 to 4500 ml (mean 1100 ml). Mean blood loss from chest drainage tubes was 650 ml (range 350–2250 ml). Reoperation for bleeding was performed in one case. Healing of the tracheal anastomosis was normal in all cases; in two patients small leaks (0.5 and 1 cm) were observed on the suture line at the intraoperative fibroscopic control. In both cases the trachea appeared normal at the second postoperative month. In conclusion, from our experience FG can be considered a useful tool during surgery for thoracic organ transplantation on account of its hemostatic and biostimulating effects. It significantly contributes to reducing both the duration of operation and postoperative blood loss.