BACKGROUND:
Postoperative pericardial adhesions have been associated with increased
morbidity, mortality, and surgical difficulty. Barriers exist to limit
adhesion formation, yet little is known about their use in cardiac
surgery. The study presented here provides the first major systematic
review of adhesion barriers in cardiac surgery.
METHODS:
Scopus and PubMed were assessed on November 20, 2020. Inclusion criteria
were clinical studies on human subjects, and exclusion criteria were
studies not published in English and case reports. Risk of bias was
evaluated with the Cochrane Risk of Bias Tool. Barrier safety and
efficacy data were assessed with Excel and GraphPad Prism 5.
RESULTS:
25 studies were identified with a total of 13 barriers and 2,928
patients. Polytetrafluoroethylene (PTFE) was the most frequently
evaluated barrier (13 studies, 67% of patients) with an infection rate
of 1.14%, bleeding event rate of 0.75%, mortality rate of 1.22%,
adhesion formation rate of 37.31%, and standardized tenacity score of
26.50. Several barriers had improved safety and efficacy. In particular,
Cova CARD had an infection rate of 0.00%, a bleeding event rate of
0.00%, and a tenacity score of 15.00.
CONCLUSIONS:
Overall, the data varied considerably in terms of study design and
reporting bias. The amount of data was also limited for the non-PTFE
studies. PTFE has historically been effective in preventing adhesions.
More recent barriers may be superior, yet the current data is
non-confirmatory. No ideal adhesion barrier currently exists, and future
barriers must focus on the requirements unique to operating in and
around the heart.
Abstract Word Count: 250