B leeding is a major sequela of cardiac surgery and is a significant cause of morbidity and death.1,2 Hemostasis can be challenging during complex cardiac surgery, particularly because of friable tissue, coagulopathy, poor visualization of the surgical field, and poor bleeding-site accessibility. Failure to achieve and maintain hemostasis and reinforce fragile tissue can result in additional bleeding, which can further reduce visibility in the operative field, increase blood loss, lengthen surgery, increase the use of blood products, and contribute to postoperative complications and reoperation. In addition to meticulous surgical technique, conventional sutures, and ligature clips, we now have a variety of therapeutic agents available to assist in hemostasis. When ligation or other conventional methods are ineffective or impractical, surgical sealants are used to prevent suture-line bleeding. During cardiac surgery, when surgeons often deal with cardiac chambers and arterial vessels that are under pressure, proper suture-line sealing is important to minimize bleeding and achieve superior clinical outcomes.We here present 2 reports on the use of CoSeal ® surgical sealant (Baxter Healthcare Corporation; Deerfield, Ill) for intraoperative bleeding during cardiac rupture repair. CoSeal, which contains a fibrin component of bovine origin, was developed as a hemostatic agent for use in cardiovascular anastomosis and is the combination of 2 synthetic polyethylene glycols, a hydrogen chloride solution, and a sodium phosphate/ sodium carbonate solution that cross-links with collagen as well as with other innate proteins adherent to the applied tissue. [4][5][6] Our studies were performed in compliance with human studies and U.S. Food and Drug Administration guidelines, and we obtained written consent from the patients after explaining the nature of the procedure.
Case ReportsPatient 1: Contained Rupture of Left Ventricle. A 51-year-old woman with a family history of early coronary artery disease and a history of smoking and drug use experienced left-sided chest pain for 10 days before seeking medical attention. On admittance to a coronary care unit at a peripheral hospital, she was diagnosed with significant ischemic cardiomyopathy and acute myocardial infarction. Echocardiography revealed severe ventricular dysfunction and a left ventricular (LV) ejection fraction of <0.20. She underwent cardiac catheterization and placement of an intracoronary stent. During that procedure, occlusion of the mid left anterior descending coronary artery was observed. She continued to develop worsening heart failure symptoms with significant systolic ventricular impairment and severe mitral regurgitation.When admitted to our facility, the patient had pulmonary edema and was dependent upon inotropic agents. She was considered a candidate for placement of an LV