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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2015 Sep 03

lingua: Inglese

Control of major pulmonary artery bleeds with a gelatin matrix-thrombin solution: a retrospective analysis

Cardillo G. 1, Carleo F. 1, Di Martino M. 1, Ciamberlano B. 1, Ialongo P. 2, Cusumano G. 3, Denitza Tinti M. 4, Ricci A. 5, Cafarotti S. 6

1 Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Roma ;
2 Unit of Radiology, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Roma;
3 Unit of Thoracic Surgery, “Vittorio Emanuele, Policlinico” Hospital Catania;
4 Unit of Cardiology, San Camillo Hospital, Azienda Ospedaliera San Camillo Forlanini, Roma;
5 Unit of Pulmonology, San Andrea Hospital, University of Rome La Sapienza, Rome;
6 Unit of Thoracic Surgery, ORBV, Bellinzona, Switzerland


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AIM: Intraoperative pulmonary artery (PA) bleeding is common during thoracic surgery. We investigated the efficacy of the gelatin matrix-thrombin solution FloSeal (Baxter International, Deerfield, IL, USA) for control of major PA bleeding.
METHODS: Retrospective data were collected on all intraoperative PA injuries during open or minimally invasive lobectomy or pneumonectomy between January 2000 and January 2014. Patients received either 4/0 prolene sutures (Standard) or the gelatin matrix-thrombin solution, plus sutures as needed (Matrix), with at least 6-month follow- up. Endpoints included time to hemostasis, total blood loss, transfusion and complications.
RESULTS: Of 2809 procedures, 39 (1.4%) had intraoperative PA injury, of which 21 received standard care and 18 the gelatin matrix-thrombin solution. Hemostasis was achieved in all Standard group patients after 2 minutes, and after 5 minutes in Matrix patients. Additional sutures were required in 4 (19.0%) Standard group patients. Three (16.7%) Matrix patients had a second solution application, while 17 (77.8%) received precautionary sutures. Mean blood loss on postoperative day 1 was 836.1±186.1 ml and 957.1±163.0 ml in the Matrix and Standard groups, respectively (p=0.003). Four (22.2%) Matrix patients received postoperative transfusions versus eight (38.0%) Standard patients (p=0.02). Two Standard and no Matrix patients underwent surgical revision. There were no complications and no mortalities.
CONCLUSION: Our analysis suggests that the gelatin matrix-thrombin solution is safe and effective for the control of major bleeding following intraoperative PA injury, and may improve outcomes. Further prospective studies are required to confirm our findings.

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gcardillo@scamilloforlanini.rm.it