In Vitro Comparison of Two Widely Used Surgical Sealants for Treating Alveolar Air Leak
09. April 2014
11. Juli 2014
10. September 2014 (eFirst)
Background Controversies surrounding the efficacy of sealants against alveolar air leak (AAL) are abundant in the literature. We sought to test the widely used sealants, TachoSil (Takeda Pharmaceutical Company Limited, Osaka, Japan) and BioGlue (CryoLife Europa Ltd., Surrey, United Kingdom) in an in vitro model.
Materials and Methods After creation of a focal superficial defect (40 × 25 mm) in swine lungs (n = 40), AAL was assessed with increasing inspired tidal volume (TVi). Upon sealant application in a randomized order, AAL was assessed in the same way until sealant burst.
Results At TVi = 400, 500, 600, and 700 mL, BioGlue achieved sealing in 19, 19, 16, and 14 tests, while TachoSil sealed in 19, 14, 4, and no test, respectively. The maximally tolerated pressure of BioGlue was higher than TachoSil (40.3 ± 3.0 vs. 36.0 ± 4.9 cm H2O, p = 0.003). Cohesive and adhesive failures were found in 10 and 1 tests of BioGlue, respectively, while all burst failures of TachoSil were adhesive. Concerning elasticity, TachoSil allowed more expansion of the covered defect than BioGlue (6.3 ± 3.9 vs. 1.4 ± 1.0 mm, p < 0.001).
Conclusion The tested sealants demonstrated high sealing efficacy. While BioGlue was superior in resisting higher ventilation pressure, TachoSil possessed better elasticity.
- 1 Belda-Sanchís J, Serra-Mitjans M, Iglesias Sentis M, Rami R. Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer. Cochrane Database Syst Rev 2010; (1) CD003051
- 2 Fabian T, Federico JA, Ponn RB. Fibrin glue in pulmonary resection: a prospective, randomized, blinded study. Ann Thorac Surg 2003; 75 (5) 1587-1592
- 3 Gika M, Kawamura M, Izumi Y, Kobayashi K. The short-term efficacy of fibrin glue combined with absorptive sheet material in visceral pleural defect repair. Interact Cardiovasc Thorac Surg 2007; 6 (1) 12-15
- 4 Rocco G, Rendina EA, Venuta F , et al. The use of sealants in modern thoracic surgery: a survey. Interact Cardiovasc Thorac Surg 2009; 9 (1) 1-3
- 5 Zhang R, Bures M, Höffler HK , et al. TissuePatch™ as a novel synthetic sealant for repair of superficial lung defect: in vitro tests results. Ann Surg Innov Res 2012; 6 (1) 12
- 6 Macchiarini P, Wain J, Almy S, Dartevelle P. Experimental and clinical evaluation of a new synthetic, absorbable sealant to reduce air leaks in thoracic operations. J Thorac Cardiovasc Surg 1999; 117 (4) 751-758
- 7 Stylli SS, Kumar A, Gonzales M, Kaye AH. The biocompatibility of BioGlue with the cerebral cortex: a pilot study. J Clin Neurosci 2004; 11 (6) 631-635
- 8 Lang G, Csekeö A, Stamatis G , et al. Efficacy and safety of topical application of human fibrinogen/thrombin-coated collagen patch (TachoComb) for treatment of air leakage after standard lobectomy. Eur J Cardiothorac Surg 2004; 25 (2) 160-166
- 9 Rickenbacher A, Breitenstein S, Lesurtel M, Frilling A. Efficacy of TachoSil a fibrin-based haemostat in different fields of surgery—a systematic review. Expert Opin Biol Ther 2009; 9 (7) 897-907
- 10 Pedersen TB, Honge JL, Pilegaard HK, Hasenkam JM. Comparative study of lung sealants in a porcine ex vivo model. Ann Thorac Surg 2012; 94 (1) 234-240
- 11 Carbon RT, Baar S, Kriegelstein S, Huemmer HP, Baar K, Simon SI. Evaluating the in vitro adhesive strength of biomaterials. Biosimulator for selective leak closure. Biomaterials 2003; 24 (8) 1469-1475
- 12 Izbicki JR, Kreusser T, Meier M , et al. Fibrin-glue-coated collagen fleece in lung surgery—experimental comparison with infrared coagulation and clinical experience. Thorac Cardiovasc Surg 1994; 42 (5) 306-309
- 13 Rocco G. Intraoperative measures for preventing residual air spaces. Thorac Surg Clin 2010; 20 (3) 371-375
- 14 Chauvet D, Tran V, Mutlu G, George B, Allain JM. Study of dural suture watertightness: an in vitro comparison of different sealants. Acta Neurochir (Wien) 2011; 153 (12) 2465-2472
- 15 Arcasoy SM, Kotloff RM. Lung transplantation. N Engl J Med 1999; 340 (14) 1081-1091
- 16 Garske LA, Tam RK, Windsor MF, Bell SC. Novel application of biological glue in the management of a complicated pneumothorax in cystic fibrosis. Pediatr Pulmonol 2002; 34 (2) 138-140
- 17 Shaw JP, Dembitzer FR, Wisnivesky JP , et al. Video-assisted thoracoscopic lobectomy: state of the art and future directions. Ann Thorac Surg 2008; 85 (2) S705 –S709
- 18 Fürst W, Banerjee A. Release of glutaraldehyde from an albumin-glutaraldehyde tissue adhesive causes significant in vitro and in vivo toxicity. Ann Thorac Surg 2005; 79 (5) 1522-1528 , discussion 1529
- 19 LeMaire SA, Schmittling ZC, Coselli JS , et al. BioGlue surgical adhesive impairs aortic growth and causes anastomotic strictures. Ann Thorac Surg 2002; 73 (5) 1500-1505 , discussion 1506
- 20 Klimo Jr P, Khalil A, Slotkin JR, Smith ER, Scott RM, Goumnerova LC. Wound complications associated with the use of bovine serum albumin-glutaraldehyde surgical adhesive in pediatric patients. Neurosurgery 2007; 60 (4) (Suppl. 02) 305-309 , discussion 309