Effect of topical N-acetylcysteine in the prevention of postoperative pericardial adhesion formation in a rabbit model

Çolak, Necmettin; Nazlı, Yunus; Alpay, Mehmet Fatih; Aksoy, Ömer; Akkaya, Ismail Olgun; Bayrak, Reyhan; Çakır, Ömer

doi:10.1016/j.carpath.2013.02.001

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…Although pericardial adhesions are a common consequence of cardiac surgery, medical and surgical therapies have not yet been established because the molecular mechanism by which adhesions develop is unclear. Previous investigators have reported several large- and middle-sized animal models of pericardial adhesions such as rabbits [5–7], pigs [10], and dogs [8, 9], which have been used to describe materials that prevent the formation of adhesion tissue. These studies have limited translation to human studies and the procedures involved often require the support of a ventilators and advanced surgical techniques, making them expensive and difficult to reproduce on larger scales.…”

Section: Discussionmentioning

confidence: 99%

“…Several animal models which have utility in the development of materials that prevent pericardial adhesions have been reported. For example, a surgical injury model by abrasion with gauze or placement of sutures has been frequently performed in rabbits [5–7], dog [8, 9], and pigs [10]. Injection of talc into the pericardial space has been reported to produce pericardial adhesions in dogs [11] and pigs [12].…”

Section: Introductionmentioning

confidence: 99%

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A simple mouse model of pericardial adhesions

Kojima

Sakaue

Okazaki

et al. 2019

J Cardiothorac Surg

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Background Postoperative pericardial adhesions are considered a risk factor for redo cardiac surgery. Several large- and medium-size animal models of pericardial adhesions have been reported, but small animal models for investigating the development of anti-adhesion materials and molecular mechanisms of this condition are lacking. In this study, we aimed to establish a simple mouse model of pericardial adhesions to address this gap. Methods We administered blood, minocycline, picibanil, and talc into the murine pericardial cavity via one-shot injection. Micro-computed tomography analyses of contrast agent-injected mice were carried out for methodological evaluation. We investigated various dosages and treatment durations for molecules identified to be inducers of pericardial adhesion. The adhesive grade was quantified by scoring the strength and volume of adhesion tissues at sacrificed time points. Histological staining with hematoxylin and eosin and Masson’s trichrome, and immunostaining for F4/80 or αSMA was performed to investigate the structural features of pericardial adhesions, and pathological features of the pericardial adhesion tissue were compared with human clinical specimens. Results Administration of talc resulted in the most extensive pericardial adhesions. Micro-computed tomography imaging data confirmed that accurate injection into the pericardial cavity was achieved. We found the optimal condition for the formation of strong pericardial adhesions to be injection of 2.5 mg/g talc for 2 weeks. Furthermore, histological analysis showed that talc administration led to an invasion of myofibroblasts and macrophages in the pericardial cavity and epicardium, consistent with pathological findings in patients with left ventricular assistive devices. Conclusions We successfully established a simple mouse model of talc-induced pericardial adhesions, which mimics human pathology and could contribute to solving the clinical issues related to pericardial adhesions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A simple mouse model of pericardial adhesions

Kojima

Sakaue

Okazaki

et al. 2019

J Cardiothorac Surg

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“…[1] Therefore, the basic methods studied to prevent adhesions include fibrinolytic agents, [2] anti-inflammatory agents, [3,4] permanent physical barriers which involve pericardial closure either directly or using an ePTFE membrane as a substitute [5,6] and resorbable barriers to prevent early fibrin deposition [7][8][9][10][11][12][13][14][15][16][17] N-acetyl cysteine have been also shown to reduce adhesions probably through fibroblast inhibition, since it is in liquid form the ideal method of application is still undetermined. [21] The closure of pericardium has been used as a barrier method to decrease the adhesions. [22] It forms natural physical barrier between the heart and the sternum.…”

Section: Discussionmentioning

confidence: 99%

Combined use of barrier methods to prevent pericardial adhesions: Is it always better?

Korun¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada bir tavşan modeli üzerinde perikard kapatılması, genişletilmiş politetrafloroetilen (ePTFE) membran ve rezorbe edilebilen adezyon bariyerinin (REPEL-CV ® ) kombine ya da ayrı ayrı kullanımının perikardiyal adezyonlar üzerine etkileri araştırıldı.Ça lış mapla nı:Otuz tavşan altı gruba randomize edildi: kontrol, perikard, genişletilmiş politetrafloroetilen, rezorbe edilebilen membran, genişletilmiş politetrafloroetilen + rezorbe edilebilen membran ve perikard + rezorbe edilebilen membran. Ameliyat sonrası beşinci haftada yapışıklıkların yoğunluğu kalitatif bir derecelendirme sistemi kullanılarak değerlendirildi ve histolojik örnekler incelendi. Bul gu lar:Rezorbe edilebilen membran grubunun tenasite skorları kontrol, perikard ve genişletilmiş politetrafloroetilen gruplarına kıyasla, anlamlı düzeyde düşük bulundu (p<0.01). Genişletilmiş politetrafloroetilen + rezorbe edilebilen membran ve perikard + rezorbe edilebilen membran gruplarının skorları, kontrol grubuna kıyasla, daha düşük bulundu (sırasıyla p<0.05 ve p<0.01). Rezorbe edilebilen membranın kombine kullanımında, tek başına kullanımına kıyasla, skorlarda anlamlı farklılık saptanmadı. Makroskopik olarak rezorbe edilebilen membran grubunda sternotomi sonrası perikard üzerinde parmak ile kolayca diseke edilebilir ince yapışıklıklar vardı. Genişletilmiş politetrafloroetilen + rezorbe edilebilen membran ve perikard + rezorbe edilebilen membran gruplarında sternum altında da yapışıklıklar izlendi.So nuç:Rezorbe edilebilen membran tek başına ya da genişletilmiş politetrafloroetilen membran veya perikard kapatılması ile kombine olarak kullanıldığında, perikardiyal adezyonları azaltmada etkiliydi. Genişletilmiş politetrafloroetilen membran ve perikardium kapanması substernal fibrozisi artırdığından, rezorbe edilebilen membranın kombine kullanımından ziyade tek başına kullanımı tercih edilebilir.Anah tar söz cük ler: Biyouyumlu malzemeler; tekrar ameliyat; cerrahi adezyonlar. ABSTRACTBackground: This study aims to investigate the effects of combined and individual use of pericardial closure, expanded polytetrafluoroethylene membrane and resorbable adhesion barrier (REPEL-CV

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“…For the study of pericardial adhesion prevention in animals, many studies, including this one, have performed animal sacrifice for adhesion evaluation two weeks after the initial adhesion-inducing surgery. [ 1 , 3 – 5 , 15 , 22 ] Other investigators have used different postoperative periods (from one day to 300 days) for the performance of re-sternotomy for adhesion evaluation in different animals including rabbits, dogs, rats, sheep and pigs[ 2 , 6 – 9 , 11 – 13 , 18 – 21 ]. For cardiac surgeons, two weeks may not be a usual time frame for a reoperation that results in significant difficulties with adhesionolysis in cardiac surgery patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Temperature-Sensitive Poloxamer Solution/Gel Material on Pericardial Adhesion Prevention: Supine Rabbit Model Study Mimicking Cardiac Surgery

et al. 2015

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ObjectiveWe investigated the mobility of a temperature-sensitive poloxamer/Alginate/CaCl2 mixture (PACM) in relation to gravity and cardiac motion and the efficacy of PACM on the prevention of pericardial adhesion in a supine rabbit model.MethodsA total of 50 rabbits were randomly divided into two groups according to materials applied after epicardial abrasion: PACM and dye mixture (group PD; n = 25) and saline as the control group (group CO; n = 25). In group PD, rabbits were maintained in a supine position with appropriate sedation, and location of mixture of PACM and dye was assessed by CT scan at the immediate postoperative period and 12 hours after surgery. The grade of adhesions was evaluated macroscopically and microscopically two weeks after surgery.ResultsIn group PD, enhancement was localized in the anterior pericardial space, where PACM and dye mixture was applied, on immediate post-surgical CT scans. However, the volume of the enhancement was significantly decreased at the anterior pericardial space 12 hours later (P < .001). Two weeks after surgery, group PD had significantly lower macroscopic adhesion score (P = .002) and fibrosis score (P = .018) than did group CO. Inflammation score and expression of anti-macrophage antibody in group PD were lower than those in group CO, although the differences were not significant.ConclusionsIn a supine rabbit model study, the anti-adhesion effect was maintained at the area of PACM application, although PACM shifted with gravity and heart motion. For more potent pericardial adhesion prevention, further research and development on the maintenance of anti-adhesion material position are required.

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Effect of topical N-acetylcysteine in the prevention of postoperative pericardial adhesion formation in a rabbit model

Cited by 14 publications

References 21 publications

A simple mouse model of pericardial adhesions

A simple mouse model of pericardial adhesions

Combined use of barrier methods to prevent pericardial adhesions: Is it always better?

Effect of Temperature-Sensitive Poloxamer Solution/Gel Material on Pericardial Adhesion Prevention: Supine Rabbit Model Study Mimicking Cardiac Surgery

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