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Management of retrosternal adhesion after median sternotomy by controlling degradation speed of a dextran and ε-poly (l-lysine)-based biocompatible glue

Abstract

Objective

Retrosternal adhesion after median sternotomy possibly raises the risk of cardiac injury at resternotomy. A biodegradable glue “Lydex” is composed of food additives, dextran and ε-poly (l-lysine), and the degradation speed can be controlled by the composition. In the present study, we evaluated the preventative effect of Lydex on retrosternal adhesion and the relationship between degradation speed and the progression of retrosternal fibrosis.

Methods

Japanese white rabbits are subjected to median sternotomy. Lydex 1, 2 and 3 were loaded at the retrosternal space of rabbits in allocated groups before sternal closure, respectively (n = 11 for each group). Retrosternal adhesion was macroscopically evaluated after surgery. Retainment of Lydex, retrosternal fibrosis and the infiltration of macrophages are histologically evaluated, respectively.

Results

All Lydex groups exhibited less retrosternal adhesion at 4 weeks after loading compared to unloaded control. The degradation speed of Lydex varied according to the compositions. Lydex with faster degradation (Lydex 2 or Lydex 3) showed lower progression of retrosternal fibrosis compared to that with slower degradation (Lydex 1) [fibrosis ratio: control vs Lydex 1 vs Lydex 2 vs Lydex 3: 0.60 ± 0.15 vs 0.18 ± 0.17 vs 0.00 ± 0.00 vs 0.00 ± 0.00, P = 0.0005 (Lydex 1 vs Lydex 2), P = 0.0005 (Lydex 1 vs Lydex 3)]. Retrosternal infiltrations of macrophages in Lydex 1 and Lydex 3 groups are not higher compared to that in unloaded control.

Conclusions

The degradation speed of Lydex could be controlled according to the compositions. The degradation speed affected the progression of retrosternal fibrosis.

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References

  1. 1.

    Yau TM, Borger MA, Weisel RD, Ivanov J. The changing pattern of reoperative coronary surgery: trends in 1230 consecutive reoperations. J Thorac Cardiovasc Surg. 2000;120:156–63.

    CAS  Article  Google Scholar 

  2. 2.

    Gallo M, Trivedi JR, Monreal G, Ganzel BL, Slaughter MS. Risk factors and outcomes in redo coronary artery bypass grafting. Heart Lung Circ. https://doi.org/10.1016/j.hlc.2019.02.008.

  3. 3.

    Lodge AJ, Wells WJ, Backer CL, O'Brien JE Jr, Austin EH, Bacha EA, et al. A novel bioresorbable film reduces postoperative adhesions after infant cardiac surgery. Ann Thorac Surg. 2008;86:614–21.

    Article  Google Scholar 

  4. 4.

    Morales D, Williams E, John R. Is resternotomy in cardiac surgery still a problem? Interact Cardiovasc Thorac Surg. 2010;11:277–86.

    Article  Google Scholar 

  5. 5.

    Bergoend E, Marchand M, Casset-Senon D, Cosnay P. Localized constrictive pericarditis after Gore-Tex pericardial substitution. Interact Cardiovasc Thorac Surg. 2010;10:813–5.

    Article  Google Scholar 

  6. 6.

    Kamitani T, Masumoto H, Kotani H, Ikeda T, Hyon SH, Sakata R. Prevention of retrosternal adhesion by novel biocompatible glue derived from food additives. J Thorac Cardiovasc Surg. 2013;146:1232–8.

    CAS  Article  Google Scholar 

  7. 7.

    Kazusa H, Nakasa T, Shibuya H, Ohkawa S, Kamei G, Adachi N, et al. Strong adhesiveness of a new biodegradable hydrogel glue, LYDEX, for use on articular cartilage. J Appl Biomater Funct Mater. 2013;11:e180–e186186.

    PubMed  Google Scholar 

  8. 8.

    Takagi K, Tsuchiya T, Araki M, Yamasaki N, Nagayasu T, Hyon SH, et al. Novel biodegradable powder for preventing postoperative pleural adhesion. J Surg Res. 2013;179:e13–e1919.

    CAS  Article  Google Scholar 

  9. 9.

    Kumar V, Abbas AK, Fausto N, Aster J. Acute and chronic inflammation. In: Smeraldi C, Lesciera P, editors. Robbins and Cotran pathologic basis of disease. 8th ed. Philadelphia: Elsevier; 2010. p. 43–77.

    Google Scholar 

  10. 10.

    Hyon SH, Nakajima N, Sugai H, Matsumura K. Low cytotoxic tissue adhesive based on oxidized dextran and epsilon-poly-l-lysine. J Biomed Mater Res A. 2014;102:2511–20.

    Article  Google Scholar 

  11. 11.

    Heydorn WH, Ferraris VA, Berry WR. Pericardial substitutes: a survey. Ann Thorac Surg. 1988;46:567–9.

    CAS  Article  Google Scholar 

  12. 12.

    Kuralay E, Bolcal C, Cingoz F, Gunay C, Yildirim V, Kilic S, et al. Cardiac reoperation by Carpentier bicaval femoral venous cannula: GATA experience. Ann Thorac Surg. 2004;77:977–81 (discussion 982).

  13. 13.

    Morishita K, Kawaharada N, Fukada J, Yamada A, Masaru T, Kuwaki K, et al. Three or more median sternotomies for patients with valve disease: role of computed tomography. Ann Thorac Surg. 2003;75:1476–80 (discussion 1481).

  14. 14.

    Athanasiou T, De LSR, Kumar P, Cherian A. Video assisted resternotomy in high-risk redo operations—the St Mary's experience. Eur J Cardiothorac Surg. 2002;21:932–4.

    Article  Google Scholar 

  15. 15.

    Kirshbom PM, Myung RJ, Simsic JM, Kramer ZB, Leong T, Kogon BE, et al. One thousand repeat sternotomies for congenital cardiac surgery: risk factors for reentry injury. Ann Thorac Surg. 2009;88:158–61.

    Article  Google Scholar 

  16. 16.

    Naitoh Y, Kawauchi A, Kamoi K, Soh J, Okihara K, Hyon SH, et al. Hemostatic effect of new surgical glue in animal partial nephrectomy models. Urology. 2013;81:1095–100.

    Article  Google Scholar 

  17. 17.

    Araki M, Tao H, Nakajima N, Sugai H, Sato T, Hyon SH, et al. Development of new biodegradable hydrogel glue for preventing alveolar air leakage. J Thorac Cardiovasc Surg. 2007;134:1241–8.

    CAS  Article  Google Scholar 

  18. 18.

    Morishima M, Marui A, Yanagi S, Nomura T, Nakajima N, Hyon SH, et al. Sustained release of vancomycin from a new biodegradable glue to prevent methicillin-resistant Staphylococcus aureus graft infection. Interact Cardiovasc Thorac Surg. 2010;11:52–5.

    Article  Google Scholar 

  19. 19.

    Takeda T, Shimamoto T, Marui A, Saito N, Uehara K, Minakata K, et al. Topical application of a biodegradable disc with amiodarone for atrial fibrillation. Ann Thorac Surg. 2011;91:734–9.

    Article  Google Scholar 

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Acknowledgements

This work was supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Science, Sports, and Culture of Japan (to T.T.) (Grant number 24592060). We thank F. Kataoka (Kyoto University) for technical supports. We thank BMG Inc, Kyoto, Japan for providing Lydex.

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Correspondence to Hidetoshi Masumoto.

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Conflict of interest

S.H.H. holds a patent right for the biodegradable glue Lydex and is one of the patent inventors. All other authors have nothing to disclose regarding commercial support.

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Takai, F., Takeda, T., Yamazaki, K. et al. Management of retrosternal adhesion after median sternotomy by controlling degradation speed of a dextran and ε-poly (l-lysine)-based biocompatible glue. Gen Thorac Cardiovasc Surg 68, 793–800 (2020). https://doi.org/10.1007/s11748-020-01297-3

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Keywords

  • Cardiac surgery
  • Median sternotomy
  • Retrosternal adhesion
  • Biomaterials