Significant adhesion reduction and time saving in pediatric heart surgery with 4DryField PH: A retrospective, controlled study

Abstract

Adhesions formation after surgery for congenital heart defects can complicate follow-up procedures due to bleeding from detached adhesion bands, injury to cardiac structures or large vessels, all of which do prolong operation times. The problem is enhanced by the fact that detached adhesions are predilection sites for new adhesions setting off a downward spiral. 4DryField® PH gel barrier has demonstrated high efficacy in reducing postoperative adhesions in general surgical and gynecological studies. This retrospective controlled study of 22 patients evaluates whether these positive results can be confirmed in pediatric cardiac surgery. Adhesions were scored from photographs of follow-up interventions by an independent cardiac surgeon blinded to group assignment. The publication provides not only score numbers but also original photographs of all sites for better traceability and transparency. In addition, timesaving due to reduced adhesions was evaluated. Results show a significantly reduced adhesion score for the 4DryField® group. Importantly, this resulted in a significantly shorter period between skin incision and start of cardiopulmonary bypass. In addition, timesaving due reduced adhesion formation was evaluated. The use of 4DryField® was safe, although higher doses per kg were used than in adults.

Evaluation of 4DryField® as an Adhesion Prophylaxis in Pediatric Patients: A Propensity-Score Matched Study

“…However, a retrospective, controlled study of 22 cardiac surgery patients was published in 2022, which described a reduced incidence of adhesions based on an assessment of photographic documentation, which reported a reduction in operating time with good tolerability. 28 The reduction in the occurrence of adhesions was also seen in the patient population examined in this study, but this was not significant. The difference in the outcome parameters could be due to the different application localization: thoracic versus intraperitoneal.…”

Paintable Decellularized‐ECM Hydrogel for Preventing Cardiac Tissue Damage

“…This result shows that the paintable hydrogel prevents lesion adhesion that normally occurs after surgery and will also not restrict the movement of the beating heart. [ 38 ] Degradation scoring (S1: fully degradation, S2: >50% degradation, and S3: non‐degradation) was performed to compare the degree of attachment of pHA_t and pdHA_t to the heart 28 days after MI induction and painting of hydrogel. Similar to the degradation behavior after subcutaneous transplantation shown in Figure S4 (Supporting Information), pdHA_t (S2: 12.5% and S3: 87.5%, n = 7/8) hardly degraded and was maintained at the site of application in the heart, unlike pHA_t (S1: 40%, S2: 40%, and S3: 20%) (Figure S7 , Supporting Information).…”

From Adhesion to Detachment: Strategies to Design Tissue‐Adhesive Hydrogels

“…[62,63] For example, failure of hemostatic adhesives can result in serious complications, as postoperative bleeding remains a significant healthcare burden associated with increased mortality and hospital admission rates. [64] In patients with gastric varices, rebleeding rates up to 71.4% have been reported following cyanoacrylate-adhesive injection, [65,66] requiring multiple rounds of adhesive glue applications which increases the risk of severe inflammation and pulmonary embolism due to excessive exposure to cyanoacrylate. [67] The mode of adhesive delivery is also important.…”