A Series of Experiences with TissuePatch™ for Alveolar Air Leak After Pulmonary Resection

Overview

Journal Gen Thorac Cardiovasc Surg

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2023 Mar 5

PMID 36871275

Authors

Takahiro Homma

Affiliations

Soon will be listed here.

Abstract

Objectives: Prolonged air leak after pulmonary resection strongly influences chest tube duration and hospitalization. This prospective study aimed to report a series of experiences with a synthetic sealant (TissuePatch™) and compare them with a combination covering method (polyglycolic acid sheet + fibrin glue) for air leaks after pulmonary surgery.

Methods: We included 51 patients (age: 20-89 years) who underwent lung resection. Patients who presented with alveolar air leak during the intraoperative water sealing test were randomly assigned to the TissuePatch™ or combination covering method groups. The chest tube was removed when there was no air leak over a period of 6 h, and no active bleeding under continuous monitoring using a digital drainage system. The chest tube duration was assessed, and various perioperative factors (such as the index of prolonged air leak score) were evaluated.

Results: Twenty (39.2%) patients developed intraoperative air leak; ten patients received TissuePatch™; and one patient who was receiving TissuePatch™ switched to the combination covering method because of broken TissuePatch™. The chest tube duration, index of prolonged air leak score, prolonged air leak, other complications, and postoperative hospitalization in both groups were similar. No TissuePatch™-related adverse events were reported.

Conclusions: Results from the use of TissuePatch™ were almost similar to those associated with the use of combination covering method in preventing prolonged postoperative air leak after pulmonary resection. Randomized, double-arm studies are required to confirm the efficacy of TissuePatch™ observed during this study.

Citing Articles

Early chest tube removal within 6 hours after thoracic surgery results in improved postoperative prognosis and no adverse effects.

Homma T, Saji H, Shimada Y, Tanabe K, Kojima K, Marushima H J Thorac Dis. 2024; 16(5):3096-3106.

PMID: 38883671 PMC: 11170371. DOI: 10.21037/jtd-23-1905.

References

Seely A, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T . Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. 2010; 90(3):936-42. DOI: 10.1016/j.athoracsur.2010.05.014. View

Dugan K, Laxmanan B, Murgu S, Hogarth D . Management of Persistent Air Leaks. Chest. 2017; 152(2):417-423. PMC: 6026238. DOI: 10.1016/j.chest.2017.02.020. View

Varela G, Jimenez M, Novoa N, Aranda J . Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg. 2005; 27(2):329-33. DOI: 10.1016/j.ejcts.2004.11.005. View

Sakata K, Reisenauer J, Kern R, Mullon J . Persistent air leak - review. Respir Med. 2018; 137:213-218. DOI: 10.1016/j.rmed.2018.03.017. View

Rivera C, Bernard A, Falcoz P, Thomas P, Schmidt A, Benard S . Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg. 2011; 92(3):1062-8. DOI: 10.1016/j.athoracsur.2011.04.033. View

Brunelli A, Monteverde M, Borri A, Salati M, Marasco R, Fianchini A . Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg. 2004; 77(4):1205-10. DOI: 10.1016/j.athoracsur.2003.10.082. View

Kim W, Lee H, Ryu H, Yoon H, Jung C . Intraoperative ventilatory leak predicts prolonged air leak after lung resection: A retrospective observational study. PLoS One. 2017; 12(11):e0187598. PMC: 5679576. DOI: 10.1371/journal.pone.0187598. View

Liang S, Ivanovic J, Gilbert S, Maziak D, Shamji F, Sundaresan R . Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection. J Thorac Cardiovasc Surg. 2012; 145(4):948-954. DOI: 10.1016/j.jtcvs.2012.08.044. View

Malapert G, Abou Hanna H, Pages P, Bernard A . Surgical sealant for the prevention of prolonged air leak after lung resection: meta-analysis. Ann Thorac Surg. 2010; 90(6):1779-85. DOI: 10.1016/j.athoracsur.2010.07.033. View

10.

Kawai H, Harada K, Ohta H, Tokushima T, Oka S . Prevention of alveolar air leakage after video-assisted thoracic surgery: comparison of the efficacy of methods involving the use of fibrin glue. Thorac Cardiovasc Surg. 2011; 60(5):351-5. DOI: 10.1055/s-0031-1293599. View

11.

Ikeda T, Sasaki M, Yamada N, Takamori A, Tanabe S, Okada A . Controlling air leaks using free pericardial fat pads as surgical sealant in pulmonary resection. Ann Thorac Surg. 2015; 99(4):1170-5. DOI: 10.1016/j.athoracsur.2014.11.040. View

12.

Hugen N, Hekma E, Claessens N, Smit H, Reijnen M . Efficacy of an Autologous Blood Patch for Prolonged Air Leak: A Systematic Review. Ann Thorac Surg. 2021; 114(3):1064-1071. DOI: 10.1016/j.athoracsur.2021.05.047. View

13.

Gilbert S, McGuire A, Maghera S, Sundaresan S, Seely A, Maziak D . Randomized trial of digital versus analog pleural drainage in patients with or without a pulmonary air leak after lung resection. J Thorac Cardiovasc Surg. 2015; 150(5):1243-9. DOI: 10.1016/j.jtcvs.2015.08.051. View

14.

Zhang R, Bures M, Hoffler H, Zinne N, Langer F, Bisdas T . TissuePatch™ as a novel synthetic sealant for repair of superficial lung defect: in vitro tests results. Ann Surg Innov Res. 2012; 6(1):12. PMC: 3542165. DOI: 10.1186/1750-1164-6-12. View

15.

Homma T, Shimada Y, Tanabe K . Decreased postoperative complications, neuropathic pain and epidural anesthesia-free effect of uniportal video-assisted thoracoscopic anatomical lung resection: a single-center initial experience of 100 cases. J Thorac Dis. 2022; 14(9):3154-3166. PMC: 9562532. DOI: 10.21037/jtd-22-6. View

16.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

17.

Homma T, Ojima T, Yamamoto Y, Shimada Y, Akemoto Y, Kitamura N . Utility of the sliding lung sign for the prediction of preoperative intrathoracic adhesions. J Thorac Dis. 2020; 12(8):4224-4232. PMC: 7475547. DOI: 10.21037/jtd-20-886. View