Use of biological absorbeable adehsion barrier to ease the surgery during staged reoperations in congenital cardiac surgery; 10 years single center experience

Objective: Reoperations are associated with an increased surgical risk due to adhesions. We prospectively evaluated a bioresorbable membrane after surgery for congenital heart defects over a 10 year period in patients who underwent “staged” procedure or in patients with potential reoperation risk.

Methods: The surgical membrane (CV Seprafilm, Genzyme, Cambridge, USA) was applied in 967 of 3183 patients; 206 of them underwent “staged” reoperatios. The membrane was applied in dry fashion to surrounding the heart in 6 pieces. Adhesions were evaluated using a subjective scoring system [1 (lowest tenacity) to 5 (highest tenacity)] and extent in percent at different region of the heart.

Results: 206 Patients were operated for right ventricular outflow tract reconstruction with valve conduit (42), functional single ventricle (44), hypoplastic left heart syndrome (84), and other diagnoses (20). Application was safe in all patients. For staged reoperations(n:206), patients received Norwood II (44), Glenn (43), total cavopulmonary connection (89). Overall mortality was 0.5% (1/206). The tenacity score was (2.6±0.5) and in the extent of adhesions (50%). Duration of reoperation was significantly reduced.

Conclusions: A bioresorbable surgical membrane leads to a significant reduction in the tenacity and amount of adhesions. It is recommended for general use whenever repeat operation is anticipated in cardiac surgery.