BACKGROUND: Postoperative pericardial adhesions have been associated
with increased morbidity, mortality, and surgical difficulty. Barriers
exist to limit adhesion formation, yet little is known about their use
in cardiac surgery. The study presented here provides the first major
systematic review of adhesion barriers in cardiac surgery. METHODS:
Scopus and PubMed were assessed on November 20, 2020. Inclusion criteria
were clinical studies on human subjects, and exclusion criteria were
studies not published in English and case reports. Risk of bias was
evaluated with the Cochrane Risk of Bias Tool. Barrier safety and
efficacy data were assessed with Excel and GraphPad Prism 5. RESULTS: 25
studies were identified with a total of 13 barriers and 2,928 patients.
Polytetrafluoroethylene (PTFE) was the most frequently evaluated barrier
(13 studies, 67% of patients) with an infection rate of 1.14%,
bleeding event rate of 0.75%, mortality rate of 1.22%, adhesion
formation rate of 37.31%, and standardized tenacity score of 26.50.
Several barriers had improved safety and efficacy. In particular, Cova
CARD had an infection rate of 0.00%, a bleeding event rate of 0.00%,
and a tenacity score of 15.00. CONCLUSIONS: Overall, the data varied
considerably in terms of study design and reporting bias. The amount of
data was also limited for the non-PTFE studies. PTFE has historically
been effective in preventing adhesions. More recent barriers may be
superior, yet the current data is non-confirmatory. No ideal adhesion
barrier currently exists, and future barriers must focus on the
requirements unique to operating in and around the heart.