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

<p>Abstract</p> <p>Background</p> <p>The use of CoSeal®, a polyethylene glycol sealant, in cardiac and vascular surgery for prevention of anastomotic bleeding has been subject to prior investigations. We analysed our perioperative data to determine the clinical benefit of using polyethylene glycol sealant to inhibit suture line bleeding in aortic surgery.</p> <p>Methods</p> <p>From January 2004 to June 2006, 124 patients underwent aortic surgical procedures such as full root replacements, reconstruction and/or replacement of ascending aorta and aortic arch procedures. A Bentall procedure was employed in 102 of these patients. In 48 of these, a polyethylene glycol sealant was added to the anastomotic closure of the aortic procedure (sealant group) and the other 54 patients did not have this additive treatment to the suture line (control group).</p> <p>Results</p> <p>There were no significant between-group differences in the demographic characteristics of the patients undergoing Bentall procedures. Mean EuroSCORES (European System for Cardiac Operative Risk Evaluation) were 13.7 ± 7.7 (sealant group) and 14.4 ± 6.2 (control group), p = NS. The polyethylene glycol sealant group had reduced intraoperative and postoperative transfusion requirements (red blood cells: 761 ± 863 <it>versus</it> 1248 ± 1206 ml, p = 0.02; fresh frozen plasma: 413 ± 532 <it>versus</it> 779 ± 834 ml, p = 0.009); and less postoperative drainage loss (985 ± 972 <it>versus</it> 1709 ± 1302 ml, p = 0.002). A trend towards a lower rate of rethoracotomy was observed in the sealant group (1/48 <it>versus</it> 6/54, p = 0.07) and there was significantly less time spent in the intensive care unit or hospital (both p = 0.03). Based on hypothesis-generating calculations, the resulting economic benefit conferred by shorter intensive care unit and hospital stays, reduced transfusion requirements and a potentially lower rethoracotomy rate is estimated at €1,943 per patient in this data analysis.</p> <p>Conclusions</p> <p>The use of this polymeric surgical sealant demonstrated improved intraoperative and postoperative management of anastomotic bleeding in Bentall procedures, leading to reduced postoperative drainage loss, less transfusion requirements, and a trend towards a lower rate of rethoracotomy. Hypothesis-generating calculations indicate that the use of this sealant translates to cost savings. Further studies are warranted to investigate the clinical and economic benefits of CoSeal in a prospective manner.</p

Haemodynamic Issues with Transcatheter Aortic Valve Implantation

Transcatheter aortic valves are typically implanted inside the native (or failed bioprosthetic’s) leaflets, permanently forcing the old leaflets open into a pseudo-cylindrical condition. Due to the passive nature of heart valves, the dynamics of the surrounding fluid environment is critical to their optimum performance. Following intervention, the haemodynamics of the region would ideally be returned to their healthy, physiological state, but major alterations are currently inevitable, such as increased peak flow velocity, the presence of stagnation regions, and increased haemolytic fluid environments. These leaflets reduce the volume of and restrict the flow into the Valsalva’s sinuses, and minimise the development of vortices and associated flow structures, which would aid washout and valve closure. Despite these differences to the healthy condition, implantation of these devices offers much improved flow from that of a moderately stenotic valve, with reduced transvalvular systolic pressure drop, peak blood velocity, and shear stress, which normally outweighs the disadvantages highlighted above, especially for high-risk patients