HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Go Watanabe Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kato, Y. Articles by Watanabe, G. Search for Related Content PubMed Articles by Kato, Y. Articles by Watanabe, G. Related Collections Pleura Coronary disease Minimally invasive surgery Chest wall

A novel technique to prevent intra-operative pneumothorax in awake coronary artery bypass grafting: biomaterial neo-pleura

Department of General and Cardiothoracic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, 920-8641, Japan

Received 4 May 2008; received in revised form 25 July 2008; accepted 30 July 2008.

^_* Corresponding author. Tel.: +81 76 265 2355; fax: +81 76 222 6833. (Email: yky43259949{at}hotmail.co.jp).

Objective: Pneumothorax caused by damaged pleura represents the biggest obstacle in awake coronary artery bypass grafting. In order to safely perform this surgery, a new technique was developed to close the damaged pleura. Methods: A rub-and-spray method was employed using polyglycolic acid nonwoven fabric and fibrin glue. At first, some fibrinogen solution was rubbed on the edge of the pleural defect and then the PGA fabric was placed and the fibrinogen and thrombin solutions were sprayed. Using a thorax model, the burst pressure caused by positive pressure and the influence of negative pressure, moisture, time, continuous respiratory movement and pleural defect size were examined. In an animal experiment using pigs, the duration spent on repair was measured and any air leakage from the pleura was also identified. Results: In the thorax model, the burst pressure was 355.9 ± 55.8 mmHg with positive pressure and no significant difference in negative pressure, moisture, time and respiratory moment was identified. However, there was a significant difference in the defect size. In the animal model, repair was easily achieved regardless of the defect size or location and air leakage was not seen after repair. The average duration of repair was 21.0 s. Conclusions: The present method achieved a strong closure with sufficient durability. Since the fabric is soft and flexible and suturing is not required, moving and fragile pleura can be easily repaired regardless of the defect location and size. Once established, the present method may be used in other forms of awake thoracic surgery or reconstruction of the thorax.

Key Words: Coronary artery bypass surgery • Less invasive surgery • Pleura • Pneumothorax • Thoracic general

This article has been cited by other articles:

				P. E. Van Schil, J. M.H. Hendriks, and P. Lauwers Editorial comment: Pleural tears: are all holes the same? Eur. J. Cardiothorac. Surg., January 1, 2009; 35(1): 41 - 42. [Full Text] [PDF]