Long-Term Outcome of Chest Wall and Diaphragm Repair with Biological Materials

Abstract

Introduction: Chest wall and/or diaphragm reconstruction aim to preserve, restore or improve respiratory function, conserve anatomical cavities and upkeep postural and upper extremity support. This can be achieved by utilizing a wide range of different grafts made of synthetic, biological, autologous or bioartificial materials. We aim to review our experience with decellularized bovine pericardium as graft in the past decade. Patients and Methods: Retrospective analysis of patients who underwent surgical chest wall and/or diaphragm repair with decellularized bovine pericardium between 01.01.2012 and 13.01.2022 at our institution. All records were screened for patients characteristics, intra/ postoperative complications, chest tube and analgesic therapy duration, length of hospital stay, presence or absence of redo-procedures as well as morbidity and 30-day-mortality. We then looked for correlations between implanted graft size and postoperative complications and gathered further follow-up information at least two months after surgery. Results: A total of n=71 patients either underwent isolated chest wall (n=51), diaphragm (n=12) or pericardial (n=4) resection and reconstruction or a combination thereof. No mortality was recorded within the first 30 days. Major morbidity occurred in 12 patients, comprising secondary respiratory failure requiring bronchoscopy and invasive ventilation in 8 patients, secondary infections and delayed wound healing requiring patch removal in 4 patients. There was no correlation between the extensiveness of the procedure and extubation timing (Chi-test, p=0.44) or onset of respiratory failure (p=0.27). Conclusion: A previously demonstrated general vailability of biological materials for various reconstructive procedures appears to be supported by our long-term results.