How adhesions form
Adhesion formation is a direct result of surgical trauma, inflammation, blood coagulation and the formation of fibrin networks connecting apposing tissue surfaces. Fibroblasts, which proliferate and move toward the site of injury, migrate into these fibrin networks where collagen and other components of extracellular matrix are deposited. This results in the formation of extensive, dense, cohesive and tenacious post-operative fibrous adhesions.
Adhesions are a major source of post-operative morbidity and, in some instances, mortality in patients who have had internal surgery. The formation of post-operative adhesions have little bearing on where in the body the surgery is performed and are present in the vast majority of patients who have had a previous surgical procedure.
Complications associated with cardiac adhesions
Adhesion formation after open-heart surgery is a well-documented, significant complication encountered during secondary procedures. Secondary procedures account for 15% to 20% of the approximately 450,000 open-heart surgeries performed annually in the United States and the 350,000 open-heart surgeries performed annually throughout the European Union. After virtually every open-heart procedure, extensive adhesions form between the epicardial surface of the heart and the inner surface of the sternum. These adhesions make sternal re-entry and accessing the heart a time-consuming and dangerous process in secondary procedures.
Sternal re-entry and dissection of post-operative cardiac adhesions expose the patient to critical risks, such as injury to the innominate vein and aorto-coronary bypass grafts.1 A 2% to 6% incidence of major vascular injury, often including the right ventricle, right atrium, or aorta has been reported.2
Removing adhesions, while essential, is a tedious and risky process that can extend the length of cardiac procedures by 60 minutes or more, entailing greater risk to the patient due to prolonged exposure to anesthesia.
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How REPEL-CV® Adhesion Barrier works
REPEL-CV Adhesion Barrier is a bioresorbable film that, when placed over the surface of the heart at the conclusion of a surgical procedure, blocks the transmission of the blood component fibrin, thereby reducing the formation of fibrin bridges between the surface of the heart and surrounding tissues. These fibrin bridges, if not blocked, typically develop into fibrous adhesions over time.
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References
1Follis FM, Pett SB Jr., Miller KB, et al. Catastrophic hemorrhage on sternal reentry: still a dreaded complication? Ann Thorac Surg. 1999;68:2215-2219.
2Elahi M, Dhannapuneni R, Firmin R, HIckey M. Direct Complications of Repeat Median Sternotomy in Adults. Asian Cardiovasc Thorac Annals. 2005;13(2):135-138.
