An An Open-Label, Single Center, Retrospective Study to Evaluate Clinical Outcomes with Surgical Sealant in Bentall Procedures: A Cohort Study
DOI:
https://doi.org/10.1532/hsf.2433Abstract
Background: Cardiovascular surgery is associated with substantial risk for postoperative bleeding with increased patient morbidity and mortality.
Numerous intraoperative techniques have been utilized to reduce this risk. This study was to assess postoperative bleeding-related parameters following Bentall procedures and to examine the impact of intraoperative surgical
sealant application.
Method: The medical/surgical records of 100 consecutive Bentall procedure cases were examined retrospectively for perioperative surgical sealant use and postoperative bleeding-related outcomes.
Results: Of the 100 patient cases, three died during the postoperative period, and 97 were evaluable. Surgical sealant was utilized in 56 patient cases (57.8%). The utilization versus no utilization of surgical sealant was associated with significant reductions in most postoperative bleeding-related parameters, including less drainage
(P = .028), resternotomy for hemorrhage (P = .036), transfusion of red blood cells (P = .022 at 48 hours; P = .027 total in-hospital), transfusion of fresh frozen plasma (P = .04 at 48 hours; P = .004 total in-hospital), and a higher percentage of cases not needing blood transfusion (P = .002). The surgical sealant group had longer cardiopulmonary bypass circuit (P = .016) and aortic cross-clamp time (P = .001), with no significant between-group differences in intubation time (P = .636) or intensive care unit duration (P = .294). When excluding urgent cases or Stanford type A aortic dissections, intensive care unit duration significantly was shorter in the surgical sealant group (P = .017). Surgical sealant use was not associated with any adverse events.
Conclusion: The application of surgical sealant to the anastomosis suture line in Bentall procedures reduces postoperative drainage, bleeding, and transfusion utilization. Further studies are warranted to investigate these benefits in prospective, randomized
clinical trials.
References
Agha RA, Borrelli MR, Vella-Baldacchino M, Thavaygan R, Orgill DP and the STROCSS Group. 2017. The STROCSS Statement: Strengthening the reporting of cohort studies in surgery. Intl J Surg 46:198-202.
Association of Perioperative Registered Nurses (AORN). 2013. Management of surgical hemostasis: An independent study guide. Published 4 Jan 2013. Available at www.slideshare.net/aornsocialmedia/hemostasis-study-guide. Accessed 12 Dec 2018.
Azadani AN, Matthews PB, Ge L, Shen Y, Jhun CS, Guy TS, Tseng EE. 2009. Mechanical properties of surgical glues used in aortic root replacement. Ann Thorac Surg 87:1154-1160.
Chu MW, Losenno KL, Moore K, Berta D, Hewitt J, Ralley F. 2013. Blood conservation strategies reduce the need for transfusions in ascending and aortic arch surgery. Perfusion 28:315-321.
D’Agostino RS, Jacobs JP, Badhwar V, et al. 2019. The society of thoracic surgeons adult cardiac surgery database: 2019 update on outcomes and quality. Ann Thorac Surg 107:24-32.
Dapunt OE, Easo J, Hölzl P, et al. 2008. Stentless full root bioprosthesis in surgery for complex aortic valve-ascending aortic disease: a single center experience of over 300 patients. Eur J Cardiothorac Surg. 33: 554-559.
DeAnda A, Elefteriades JA, Hasaniya NW, Lattouf OM, Lazzara RR. 2009. Improving outcomes through the use of surgical sealants for anastomotic sealing during cardiovascular surgery. J Card Surg 24:325-333.
Elefteriades JA. 2009. How I do it: utilization of high-pressure sealants in aortic reconstruction. J Cardiothorac Surg 4:27.
Ferraris VA, Brown JR, Despotis GJ, et al. 2011. Society of Thoracic Surgeons Blood Conservation Guideline Task Force. 2011 Update to the society of thoracic surgeons and the society of cardiovascular anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 91:944-982.
Geissler RG, Rotering H, Buddendick H, et al. 2015. Utilization of blood components in cardiac surgery: a single-centre retrospective analysis with regard to diagnosis-related procedures. Transfus Med Hemother 42:75-82.
Glickman M, Gheissari A, Money S, Martin J, Ballard JL. 2002. CoSeal Multicenter Vascular Surgery Study Group, A polymeric sealant inhibits anastomotic suture hole bleeding more rapidly than gelfoam/thrombin: results of a randomized controlled trial. Arch Surg 137:326-332.
Hagberg RC, Safi HJ, Sabik J, Conte J, Block JE. 2004. Improved intraoperative management of anastomotic bleeding during aortic reconstruction: results of a randomized controlled trial. Am Surg 70:307-311.
Hei F, Zhu DM, Hou XT. 2017. Chinese white paper on cardiac surgery and CPB white paper. Chin J ECC 15:65-67.
Milne AA, Murphy WG, Reading SJ, Ruckley CV. 1996. A randomized trial of fibrin sealant in peripheral vascular surgery. Vox Sang 70:210-212.
Natour E, Suedkamp M, Dapunt OE. 2012. Assessment of the effect on blood loss and transfusion requirements when adding a polyethylene glycol sealant to the anastomotic closure of aortic procedures: a case–control analysis of 102 patients undergoing Bentall procedures. J Cardiothorac Surg 7:105.
Robich MP, Koch CG, Johnston DR, et al. 2015. Trends in blood utilization in United States cardiac surgical patients Transfusion 55:805-814.
Velasquez CA, Singh M, Mahmood SU, et al. 2017. The effect of blood transfusion on outcomes in aortic surgery. Int J Angiol 26:135-142.
