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Adhesion Barriers in Cardiac Surgery: A Systematic Review of Safety and Efficacy
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  • William Head,
  • Namrata Paladugu,
  • Jennie Kwon,
  • Emily Brennan,
  • Minoo Kavarana,
  • Taufiek Konrad Rajab
William Head
Medical University of South Carolina

Corresponding Author:[email protected]

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Namrata Paladugu
Medical University of South Carolina
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Jennie Kwon
Medical University of South Carolina
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Emily Brennan
Medical University of South Carolina
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Minoo Kavarana
Medical University of South Carolina
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Taufiek Konrad Rajab
Medical University of South Carolina
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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.
31 Aug 2021Submitted to Journal of Cardiac Surgery
31 Aug 2021Submission Checks Completed
31 Aug 2021Assigned to Editor
31 Aug 2021Reviewer(s) Assigned
07 Sep 2021Review(s) Completed, Editorial Evaluation Pending
07 Sep 2021Editorial Decision: Revise Major
03 Oct 20211st Revision Received
04 Oct 2021Submission Checks Completed
04 Oct 2021Assigned to Editor
04 Oct 2021Reviewer(s) Assigned
04 Oct 2021Review(s) Completed, Editorial Evaluation Pending
04 Oct 2021Editorial Decision: Accept