Postoperative Pericardial Adhesion Prevention Using Carbylan-SX in a Rabbit Model

• Published in: The Journal of surgical research 2007-06, Vol.140 (2), p.237-242
• Main Authors: Connors, Rafe C., M.D, Muir, Jeffery J., B.A, Liu, Yanchun, M.D, Reiss, G. Russell, M.D, Kouretas, Peter C., M.D., Ph.D, Whitten, Matthew G., M.D, Sorenson, Tyler K., B.A, Prestwich, Glenn D., Ph.D, Bull, David A., M.D
• Format: Article
• Language: English
• Subjects: adhesion prevention; Animals; Biological and medical sciences; Carbylan; Cardiac Surgical Procedures - methods; Disease Models, Animal; Gelatin - therapeutic use; General aspects; Hyaluronic Acid - analogs & derivatives; Hyaluronic Acid - therapeutic use; Hydrogels - therapeutic use; Male; Medical sciences; pericardial adhesions; Pericardium - pathology; Pericardium - surgery; Polyethylene Glycols - therapeutic use; Postoperative Complications - pathology; Postoperative Complications - prevention & control; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rabbits; retrosternal adhesions; Seprafilm; Surgery; Tissue Adhesions - pathology; Tissue Adhesions - prevention & control
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2007.03.014

Introduction The presence of dense adhesions within the pericardial space complicates reoperative cardiac surgery. Prior attempts to reduce adhesion formation after primary cardiac surgery using medications or biomaterials have had variable success. Carbylan-SX (Carbylan Biosurgery Inc., Palo Alto, CA) is a hyaluronan-based biomaterial, which has been shown to be effective at reducing adhesions in a nonthoracic rat model. This study evaluates whether Carbylan-SX can effectively reduce postoperative adhesions within the pericardial cavity. Methods Thirty-eight New Zealand white rabbits underwent a left lateral thoracotomy. A pericardiotomy was made and epicardial adhesions were induced on the anterior surface of the heart using a Dremel device (Racine, WI). The rabbits were divided into four groups: controls with abrasions only receiving no treatment ( n = 10), Carbylan-SX films ( n = 10), Carbylan-SX aerosolized hydrogel ( n = 10), and Seprafilm ( n = 8). The pericardial sac and chest were subsequently closed. Rabbits were sacrificed at a mean of 15 days. For histological analysis, each heart was divided into 12 separate 1 mm sections. Computer imaging software was used to measure the adhesion thickness and the mean of 12 random measurements for each animal was recorded and statistical analysis performed. Results Histological analysis revealed all treatment groups to be significantly better than the control (2159 μm thickness, P < 0.0001) at preventing adhesions. The Carbylan-SX film and Carbylan-SX aerosolized hydrogel both proved to be better at preventing adhesions than Seprafilm (Genzyme Corp., Cambridge, MA) with an average adhesion thickness of 454 and 577 μm, respectively, compared with 1319 μm for Seprafilm ( P < 0.0001 and P < 0.0005, respectively). The Carbylan-SX film and Carbylan-SX aerosolized hydrogel were equally effective at preventing adhesion formation. Conclusion Carbylan-SX film and Carbylan-SX aerosolized crosslinkable hydrogel are equally effective methods of reducing postoperative pericardial adhesions within the pericardial cavity. Both the Carbylan-SX film and aerosolized hydrogel showed a significantly greater reduction in adhesions than Seprafilm. Clinical application of Carbylan-SX could have significant therapeutic implications in the future.