Expanded polytetrafluoroethylene membranes to wrap surfaces of circulatorysupport devices in patients undergoing bridge to heart transplantation

Objective: Because of a lack of donor hearts, an increasing number of patie nts with heart failure must now undergo bridge to cardiac transplantation w ith a mechanical circulatory support device. Moreover, support periods have become longer. As a result, pericardial adhesions may develop while the su pport device is implanted, increasing the risk of injury at resternotomy an d bleeding after transplantation. Use of expanded polytetrafluoroethylene ( ePTFE) pericardial substitutes (membranes) may prevent such adhesions. Pati ents and methods: From January 1997 to December 1999, ePTFE membranes were used in 23 patients to wrap portions of an implanted left ventricular assis t device (LVAD) or total artificial heart (TAH). Any complications during m echanical support or at cardiac transplantation were recorded. Six ePTFE me mbranes removed at transplantation were studied histologically. Results and conclusions: At resternotomy for transplantation, the plane of dissection between tissues, ePTFE membranes, and surfaces of the mechanical support de vice were easily discerned. No adhesions were observed between tissues and membranes. There were no injuries during resternotomy and no patient had to undergo reoperation because of bleeding. One patient given a TAH had an in fection during circulatory support that was controlled by antibiotic therap y. In another patient, clots developed between the device and an ePTFE memb rane; these were removed successfully. Histologic studies of removed ePTFE membranes showed no infiltration of the membranes interstices by collagen o r cellular components. Use of ePTFE membranes in patients undergoing bridge to transplantation with either an LVAD or a TAH limited adhesions between tissues and device surfaces without increasing the risk of infection. (C) 2 001 Elsevier Science B.V. All rights reserved.