The Role of Biosurgical Hemostatic Sealants in Cardiac Surgery

Abstract

The focus on superb quality and value of medical and surgical care has become a cornerstone of modern clinical practice. Within the realm of cardiothoracic surgery, quality is synonymous with technically excellent, safely conducted operative procedure followed by an uneventful patient recovery and follow-up. Critical to this process of clinical value creation is meticulous attention to all aspects of every step along the management continuum. From surgical quality improvement perspective, the reduction in blood loss and thus minimization of blood/blood product transfusions are of critical importance. This chapter focuses on the role of biosurgicals as useful adjuncts to achieving the ultimate goal of uneventful cardiac procedure and thus set the patient's clinical course for optimal postoperative recovery and longterm well-being.

Biosurgical Materials in Neurosurgical Applications: From Pioneers to Leaders

“…It is important to realize that biosurgical agents are adjuncts to hemostasis when standard methods like direct pressure, suturing, or cautery are impractical or ineffective [107,108]. Good knowledge of the mechanism of action of different available biosurgical hemostats is critical, with multiple considerations including the patient's anticoagulation status, the rate of bleeding, the presence of thrombocytopenia, fibrinogen level assessment, and many other factors.…”

“…• Defects in the clotting cascade -either physiologic, such as inherent factor deficiencies (hemophilia), secondary to pathologic conditions (renal failure, acquired Von Willebrand's disease in aortic stenosis), or iatrogenic from medical therapies such at anti-coagulants and anti-platelet agents. Even the act of surgical incisions and minor tissue trauma can activate various components of the clotting cascade and thus complicate bleeding management [138,139].…”

“…• Temperature management -Clotting is a complex enzymatic process that has evolved to be optimal at physiologic temperatures. Hypothermia, either environmental after trauma, perioperative, or therapeutic (for witnessed cardiac arrests, for example) can have potential adverse effects on hemostasis and must be considered in the context of a bleeding patient [108,138,139].…”

Operative Hemostasis in Trauma and Acute Care Surgery: The Role of Biosurgical Agents

“…Adhesive agents, whether liquid or fibrin patch, contain thrombin and fibrin thereby facilitating the final steps of the coagulation cascade [5,11]. These added factors may help facilitate hemostasis in patients with various functional impairments within the coagulation cascade [15,16]. Alterations within the coagulation mechanism that lead to the so-called "non-surgical bleeding" may be due to coagulopathy of massive traumatic hemorrhage, large intraoperative blood losses, or sepsis secondary to gastrointestinal perforation [8,[17][18][19][20].…”

Biologic Hemostatic Agents in Obstetrics and Gynecology

“…Topical hemostatic agents work by augmenting specific parts of physiologic hemostasis. Of the four phases of hemostasis [1,2], topical hemostatic agents primarily affect formation of the platelet plug and propagation of the coagulation cascade. Topical hemostatic agent use is common practice in many surgical procedures, and has been utilized across all surgical specialties [3].…”