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.
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.
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.
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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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.
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
- Cardiac surgery
- Median sternotomy
- Retrosternal adhesion