Local Hemostasis with Fibrin Glue after Intracardiac Repair of Tetralogy of Fallot and Transposition of the Great Arteries

Abstract

In the last year fibrin glue Tissucol was used for local hemostasis in 21 patients subjected to correction of tetralogy of Fallot (ToF) and in 10 patients subjected to Senning-procedure in transposition of the great arteries (TGA). The postoperative blood loss was compared with the blood loss of 20 ToF-patients and 10 TGA-patients who had undergone correction one year ago without fibrin glue. Between the 2 groups were no differences in age, sex, bodyweight (BW), coagulation state or operative management. Two hours postoperatively the blood loss with fibrin glue was 2.2 ml/hr/kg BW in ToF-patients and 2.4 ml/hr/kg BW in TGA-patients, whereas without fibrin glue it was 4.2 ml/hr/kg BW in ToF (p less than 0.01) and 4.5 ml/hr/kg BW in TGA (p less than 0.01). The same significant difference (p less than 0.01) was found 6 hours postoperatively with 1.4 versus 2.2 ml/hr/kg BW in ToF and 1.9 versus 2.5 ml/hr/kg BW in TGA. Over the following 18 hours the secretion from the chest tubes was identical in both groups. Six patients with ToF and one patient with TGA required reoperation for bleeding. The blood loss per kg BW per hour at reoperation was 6.9 ml with and 8.2 ml without fibrin glue (N.S.). The blood loss of patients who did not require reoperation at the same time was 4.6 times lower with fibrin glue and only 3.7 times lower without fibrin glue. Fibrin glue reduces blood loss after intracardiac repair of ToF and TGA by local hemostasis at patches and suture lines. The application of fibrin glue can facilitate differentiation of surgical bleedings and the indication for reoperations.

Contribution of fibrin glue in the surgery of cyanogenic and non-cyanogenic congenital cardiopathies: retrospective cohort study

“…The authors compared postoperative blood loss to 20 ToF patients and 10 TGA patients who had a correction one year ago without fibrin glue and found that two hours after surgery, bleeding with fibrin glue was lower than without fibrin glue ( p < 0.01) in patients with ToF and TGA. Over the next 18 h, the secretion of thoracic drains was identical in both groups [23]. This result could be considered similar to our result since the overall bleeding volume is similar in both groups.…”

Use of Fibrin Sealants in Cardiovascular Surgery: A Systematic Review

“…TISSEEL has also been shown to be effective in repairing multiple VSDs in children, with good short‐ and long‐term results . Other reports describing TISSEEL use in major cardiac surgery include retrospective controlled studies that supported the ability of TISSEEL to reduce blood loss (assessed using chest tube outputs) during open‐heart surgery in adult and pediatric patients …”

A prospective randomized study comparing fibrin sealant to manual compression for the treatment of anastomotic suture-hole bleeding in expanded polytetrafluoroethylene grafts

“…They have shown beneficial results with respect to significantly shorter times to hemostasis than other commonly used agents/techniques in a variety of complex clinical situations 1,[6][7][8][11][12][13][14][15][16][17][18] and with respect to significant decreases in mortality and morbidity in spleen and liver injuries. 19 Our prospective controlled study evaluated the efficacy and safety of a fibrin sealant containing 500 IU/mL thrombin and synthetic aprotinin (referred to herein as FS) for the treatment of anastomotic suture-hole bleeding that is not amenable to additional sutures during placement of ePTFE vascular grafts.…”