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Ann Thorac Surg 1987;44:529-531
© 1987 The Society of Thoracic Surgeons

Articles

Reduction of Perioperative Hemorrhage by Anterior Mediastinal Spray Application of Fibrin Glue during Cardiac Operations

William D. Spotnitz, M.D.*, M. Susan Dalton, B.S., Joseph W. Baker, M.D., Stanton P. Nolan, M.D.

From the Department of Surgery, University of Virginia Medical Center, Charlottesville, VA

Accepted for publication May 6, 1987.

* Address reprint requests to Dr. Spotnitz, Department of Surgery, Box 181, University of Virginia Medical Center, Charlottesville, VA 22908

A variety of published techniques for the production of concentrated fibrinogen from units of screened single-donor human plasma have led to increasing clinical use of fibrin glue in the United States. We have adapted a method of applying this material with a disposable plastic sprayer. In 20 consecutively treated patients, fibrin glue was sprayed on the anterior mediastinum before closure of the median sternotomy incision. A control group of 20 patients undergoing the identical cardiac operations (13 coronary artery bypass grafting procedures [CABG], 4 valve replacements [including 1 reoperative procedure], and 3 combined valve replacements and CABG) by the same surgeon within a one-year period was chosen for comparison of chest tube outputs. Specifically, chest tube outputs were as follows for treated and untreated patients, respectively: at 12 hours, 461 ± 40 ml (mean ± 1 standard error of the mean versus 731 ± 80 ml; at 24 hours, 714 ± 73 ml versus 1,016 ± 109 ml; and at 48 hours, 863 ± 93 ml versus 1,187 ± 137 ml. The differences between control and spray chest tube output are statistically significant by unpaired t test (p < 0.05) at both 12 and 24 hours. Thus, this method can reduce perioperative hemorrhage from the anterior mediastinum after cardiac operations.




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