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Control of major pulmonary artery bleeding with a gelatin matrix-thrombin solution: a retrospective analysis.

Control of major pulmonary artery bleeding with a gelatin matrix-thrombin solution: a retrospective analysis.

Cardillo G, Carleo F, DI Martino M, Ciamberlano B, Ialongo P, Cusumano G, Denitza Tinti M, Ricci A, Cafarotti S.

J Cardiovasc Surg (Torino). 2017 Dec;58(6):904-908. doi: 10.23736/S0021-9509.16.09010-8. Epub 2015 Sep 3.

PMID: 26337014

BACKGROUND:

Intraoperative pulmonary artery (PA) bleeding is common during thoracic surgery. We investigated the efficacy of the gelatin matrix-thrombin solution FloSeal (Baxter International, Deerfield, IL, USA) for control of major PA bleeding.

METHODS:

Retrospective data were collected on all intraoperative PA injuries during open or minimally invasive lobectomy or pneumonectomy between January 2000 and January 2014. Patients received either 4/0 prolene sutures (Standard) or the gelatin matrix-thrombin solution, plus sutures as needed (Matrix), with at least 6-month follow-up. Endpoints included time to hemostasis, total blood loss, transfusion and complications.

RESULTS:

Of 2809 procedures, 39 (1.4%) had intraoperative PA injury, of which 21 received standard care and 18 the gelatin matrix-thrombin solution. Hemostasis was achieved in all Standard group patients after 2 minutes, and after 5 minutes in Matrix patients. Additional sutures were required in 4 (19.0%) Standard group patients. Three (16.7%) Matrix patients had a second solution application, while 17 (77.8%) received precautionary sutures. Mean blood loss on postoperative day 1 was 836.1±186.1 mL and 957.1±163.0 mL in the Matrix and Standard groups, respectively (P=0.003). Four (22.2%) Matrix patients received postoperative transfusions versus eight (38.0%) Standard patients (P=0.02). Two Standard and no Matrix patients underwent surgical revision. There were no complications and no mortalities.

CONCLUSIONS:

Our analysis suggests that the gelatin matrix-thrombin solution is safe and effective for the control of major bleeding following intraoperative PA injury, and may improve outcomes. Further prospective studies are required to confirm our findings.

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