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Bioabsorbable Gelatin Sheets Latticed With Polyglycolic Acid Can Eliminate Pericardial Adhesion  Ichiro Yoshioka, MD, Yoshikatsu Saiki, MD, Kei Sakuma,

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Presentation on theme: "Bioabsorbable Gelatin Sheets Latticed With Polyglycolic Acid Can Eliminate Pericardial Adhesion  Ichiro Yoshioka, MD, Yoshikatsu Saiki, MD, Kei Sakuma,"— Presentation transcript:

1 Bioabsorbable Gelatin Sheets Latticed With Polyglycolic Acid Can Eliminate Pericardial Adhesion 
Ichiro Yoshioka, MD, Yoshikatsu Saiki, MD, Kei Sakuma, MD, Atsushi Iguchi, MD, Takuya Moriya, MD, Yoshito Ikada, PhD, Koichi Tabayashi, MD  The Annals of Thoracic Surgery  Volume 84, Issue 3, Pages (September 2007) DOI: /j.athoracsur Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 External appearance of the gelatin sheet with polyglycolic acid incorporated into the sheet as a latticework. Each square is 2.5 × 2.5 mm in size. The sheet is adequately malleable for surgical manipulation, and it can be cut to a desired shape. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Macroscopic findings on the bioabsorbable pericardial substitutes: (A) 2 weeks, (B) 4 weeks, (C) 12 weeks, and (D) 24 weeks after implantation. The gelatin sheet remains in place with the latticework. (A) The sheet was easily separated from the epicardium by finger dissection after the 2-week interval. (B) The internal appearance of the pericardium after blunt dissection at the 4-week interval shows that the outer circumferential area has been absorbed. (C) The bioabsorbable gelatin/PGA sheet has generated no adhesion over the epicardium by 12 weeks after implantation. The sheet has been replaced by a thin membrane. Note the identifiable anatomical structure beneath the sheet unlike the obscured anatomy with thick fibrous tissue commonly seen after ePTFE sheet implantation. (D) By 24 weeks after implantation, the sheet was completely absorbed and replaced with the regenerated pericardium. The surface of the heart was smooth and developed no adhesion or fibrosis. (In each illustration, the arrows indicate the replaced pericardial defect.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Histologic sections of the implanted gelatin sheet (g) latticed with polyglycolic acid (PGA [p]) after (A) the 2-week, (B) the 4-week, (C) the 12-week, and (D) the 24-week interval. (A, B, C: original magnification ×40. D: original magnification ×100; elastica Masson staining.) (A) The gelatin/PGA sheet remains on the surface of the epicardium with loose adhesion. (B) The gelatin has been partially biodegradated, and the PGA fibers are exposed to the surface and surrounded by inflammatory cells and fibrous connective tissue (arrow heads) after the 4-week interval. (C) By 12 weeks after implantation, there is almost no residual gelatin or PGA. The sheet has been replaced with the bilayer-like fibrous connective tissue (asterisk). The structure beneath the regenerated pericardium in this picture is the lung. (D) At 24 weeks after implantation, the regenerated fibrous connective tissue has matured and has become thinner (asterisk). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 (A, B) Immunohistochemical staining of the regenerated pericardium 24 weeks after operation using anticytokeratin antibody and anti-HBME-1 antibody. The cells on the surface layers are positive for cytokeratin (A) and HBME-1 (B). The regenerated pericardium mimics the structure of the native pericardium (original magnification ×200). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

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