Cytocompatibility and mechanical properties of surgical sealants for cardiovascular applications

Abstract

Objectives: The present study compared physical, mechanical, and biologic characteristics of four clinically available surgical sealants for cardiovascular repair. Methods: BioGlue®, PreveLeak®, Tridyne ™ VS, and Coseal® were compared for the following properties: hydrated swelling, cytocompatibility, burst strength, biaxial stretching (elasticity), and in vitro degradation. Results: Sealants showed a wide range of swelling upon hydration. By gravimetric and volumetric measurement, swelling was greatest for Coseal® followed by Tridyne ™ VS, BioGlue®, and PreveLeak®. Tridyne ™ VS was the most cytocompatible based on Alamar Blue assay results, supporting 85% cell survival compared to 36–39% survival with the other sealants. All sealants withstood pressure above mean arterial pressure (70–110 mmHg) and physiologic systolic blood pressure (90–140mmHg) in an ex vivo arterial flow burst model; lowest peak pressure at failure was PreveLeak® at 235±48 mmHg, highest peak pressure at failure was BioGlue® at 596±72 mmHg. Biaxial tensile testing showed no differences in elasticity between ex vivo porcine aorta and carotid arteries and Tridyne™ VS or Coseal® while BioGlue® and PreveLeak® were significantly stiffer. In vitro degradation time for Coseal® was 6 days, and 21 days for Tridyne ™ VS. No degradation was observed in BioGlue® or PreveLeak® for 30 days. Conclusions: Although all sealants withstood supraphysiological arterial pressure, there were differences in characteristics that may be important in clinical outcome. Coseal® degradation time was short compared to other sealants whereas BioGlue® and PreveLeak® showed a significant compliance mismatch with native porcine carotid artery. Tridyne™ VS was significantly more cytocompatible than the other three sealants.

Tissue reactions to polyethylene glycol and glutaraldehyde-based surgical sealants in a rabbit aorta model

“…37 A further study evaluated the cytotoxicity of the degradation products of BioGlue and Coseal formed after incubation of the materials in cell culture medium for 7 days. 31 When cells were cultured in the resulting solutions for 24 h, no significant differences in cytotoxicity were observed. However, it should be noted that such a system is not representative of the in vivo situation, as it does not take into consideration diffusion of the degradation products away from the site of application.…”

“…Coseal was designed to hydrolytically degrade within 1-2 weeks. Murdock et al 31 has shown an in vitro hydrolytic degradation time in a standardised ASTM in vitro test of 6 days for Coseal, while BioGlue did not degrade over 30 days. Hill et al 27 has shown that 'small amounts of CoSeal were visible grossly or histologically at day 7'.…”

“…Murdock et al. 31 has shown an in vitro hydrolytic degradation time in a standardised ASTM in vitro test of 6 days for Coseal, while BioGlue did not degrade over 30 days. Hill et al.…”

Treating bleeding beyond correction stitches—or better, how to enhance hemostasis by topical pharmacologic support

“…This is where the value of the study in this issue of the Journal by Murdock and colleagues 4 lies, teaching us that different sealants have different polymerization times, cytocompatibility properties, burst pressure strengths, elastic properties, and, finally, degradation times, and that these effects are not negligible. 4 In addition, a dose effect in certain sealants is to be anticipated, although this remains subject to continuing studies.…”

“…Summarizing, this study of Murdock and colleagues 4 should be interpreted as a plea to the surgical community to pay attention to detail with regard to the sealants used in daily clinical practice, to be informed on their modes of action, and to anticipate interaction with local tissue beyond the acute effect of enhancing hemostasis.…”