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Ann Thorac Surg 1987;43:383-385
© 1987 The Society of Thoracic Surgeons

Articles

Pericardial Substitutes: Delayed Reexploration and Findings

John C. Opie, M.D., F.R.C.S. (Lon)(C)*, Alberto J. Larrieu, M.D., I. Scott Cornell, M.D.

Department of Cardiothoracic Surgery, British Columbia's Children's Hospital, Vancouver, BC, Canada, Department of Cardiothoracic Surgery, Albert Einstein Medical Center, Medical College of Pennsylvania, Department of Pathology, New York Hospital Cornell Medical Center, New York, NY

Accepted for publication June 18, 1986.

* Address requests to Dr. Opie, 350-943 W Broadway, Vancouver, BC, Canada V5Z 4E1

Four patients' experience with two varieties of pericardial substitutes has been evaluated. Two patients received glutaraldehyde-preserved, formalin-fixed bovine bioprosthetic pericardial substitutes. These were associated with dense prosthesis-to-epicardium adhesions and the formation of a thick gelatinous peel. Two other patients received glutaraldehyde-preserved, ethanol-fixed bovine bioprosthetic pericardial substitutes. One patient had minimal prosthesis-to-epicardium adhesions, and the remaining patient demonstrated moderate prosthesis-to-epicardium adhesions with giant-cell and lymphocyte fibrosis. In all patients prosthesis-to-sternum adhesions were minimal.

These observations suggest that careful washing is essential in all bioprosthetic implants to eliminate residual preservatives and fixatives. In addition, preservation in ethanol is associated with less prosthesis-epicardium reaction than is formalin preservation. Both products are successful in easing reentry, and no episode of infection has been associated with either prosthesis.




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