Three-layered synthetic pericardial substitutes reduce postoperative pericardial adhesions Noriyoshi Kajihara, MD, Masataka Eto, MD, Yasuhisa Oishi,

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Three-layered synthetic pericardial substitutes reduce postoperative pericardial adhesions Noriyoshi Kajihara, MD, Masataka Eto, MD, Yasuhisa Oishi, MD, Noriko Boku, MD, Kunio Kuwahara, BS, Naoki Nishiguchi, MS, Chikara Kotani, Shigeki Morita, MD The Journal of Thoracic and Cardiovascular Surgery Volume 129, Issue 1, Pages 18-24 (January 2005) DOI: 10.1016/j.jtcvs.2004.03.010

Figure 1 Scanning electron microscopic views of the cross sections of the sheet (original magnification, ×100). A, The 3 layers of the UBE sheet: a middle layer of polyester is inserted between 2 layers of silicone-urethane copolymer. B, The ePTFE sheet, consisting of 1 layer. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 18-24DOI: (10.1016/j.jtcvs.2004.03.010)

Figure 2 Scanning electron microscopic views of the adherent platelets on surfaces of the sheets. Platelet-rich plasma was put on the UBE sheet for 10 minutes (A) and 40 minutes (C) and on the ePTFE for 10 minutes (B) and 40 minutes (D). The Journal of Thoracic and Cardiovascular Surgery 2005 129, 18-24DOI: (10.1016/j.jtcvs.2004.03.010)

Figure 3 The appearances of the sheets 3 months after implantation. A, The sheets of group I retained the implanted form. B, The sheets of group II were crinkled, less pliable, and thickened by a dense layer of fibrous tissue. C, In group I, there were no adhesions to the sheets, including the suture line, and there were minimum epicardial reactions. D, In group II, there were moderate adhesions to the sheets and severe epicardial reactions. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 18-24DOI: (10.1016/j.jtcvs.2004.03.010)

Figure 4 Cross sections through the tissue on the surface of the heart beneath the sheet (original magnification, ×40). A, Group I, hematoxylin and eosin staining. B, Group II, hematoxylin and eosin staining. C, Group I, Azan-Mallory staining. D, Group II, Azan-Mallory staining. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 18-24DOI: (10.1016/j.jtcvs.2004.03.010)

Figure 5 Macrophages in the layer covering the epicardium were stained with MAC387. A, In group I, a small number of macrophages existed. B, In group II, a large number of macrophages were recognized. C, The numbers of macrophages in the layer covering the epicardium are expressed as box and whisker plots. Horizontal lines in boxes denote 25th, 50th, and 75th percentile values from the bottom. The lower and upper whisker plots show minimum and maximum values, respectively. Group I shows fewer macrophages compared with group II. The number is the sum of the cell counts on 3 fields at ×400 magnification. *P = .045 versus group II. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 18-24DOI: (10.1016/j.jtcvs.2004.03.010)

The Journal of Thoracic and Cardiovascular Surgery 2005 129, 18-24DOI: (10.1016/j.jtcvs.2004.03.010)