Hk. Kjaergard et Je. Fairbrother, CONTROLLED CLINICAL-STUDIES OF FIBRIN SEALANT IN CARDIOTHORACIC SURGERY - A REVIEW, European journal of cardio-thoracic surgery, 10(9), 1996, pp. 727-733
Objective. More than 2300 clinical papers have been published on the s
urgical applications of fibrin sealant (FS), with the largest number i
n the speciality of cardiothoracic surgery. The purpose of this review
of the literature was to find and evaluate controlled studies publish
ed in the field of cardiothoracic surgery, to clarify the indications
and emphasize the benefits of FS available to the practising surgeon.
Methods. A database of the surgical publications of FS was created. Up
to the end of 1995, at least 24 controlled clinical studies had been
published; these may bit divided into 20 studies with a positive outco
me and 4 studies where the results were not different from the control
s. In none of the studies was the clinical result worse after the use
of FS. Results. In most of the cardiac studies, FS was successfully us
ed at bleeding sites in reoperations and in congenital heart surgery.
Postoperative bleeding may also be reduced by the anterior mediastinal
spray application of FS or by preparing woven Dacron prostheses with
the sealant. In addition, FS has been found to improve results after t
ype A aortic dissections and, by adding an antibiotic to the sealant.
the postoperative infection rate for active endocarditis of the aortic
root can be reduced. In pulmonary surgery FS can be used to reduce pu
lmonary air leakage, however the results of some studies diverge due t
o different clinical test conditions and the inclusion of only a small
number of patients in the ''negative'' studies. In none of the contro
lled studies of esophageal surgery could FS prevent leakage from esoph
ageal anastomoses. Conclusions. Fibrin sealant is safe when it is appl
ied properly, but there is a learning curve for surgeons who start usi
ng it. An autologous sealant or a sealant containing human instead of
bovine thrombin is preferred, since repeated use of bovine thrombin ma
y induce coagulopathies. The number of controlled clinical studies of
FS is currently increasing, with the majority of the papers revealing
a beneficial effect of FS when it is used as a hemostatic or sealing a
gent in cardiothoracic surgery.