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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 929-934, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Experience with the polytetrafluoroethylene surgical membrane for pericardial closure in operations for congenital cardiac defects

JJ Amato, JV Cotroneo, RJ Galdieri, E Alboliras, J Antillon and RL Vogel
Children's Hospital of New Jersey, Department of Pediatric Cardiovascular Surgery, University of Medicine and Dentistry of New Jersey 07107.

From 1984 through 1987, pericardial closure for 96 patients who underwent repair of congenital heart defects was completed with placement of a polytetrafluorethylene surgical membrane. Ages ranged from 1 day to 20 years (median age 2.1 years), and weight ranged from 2.7 to 44.6 kg (median weight 10.7 kg). Use of the membrane increased over the 4-year period. The patients were divided into three groups according to probability of reoperation: group I, low probability (35 patients); group II, intermediate probability (41 patients); and group III, high probability (20 patients). Early postoperatively there were no infections in any group and no complications attributable to the polytetrafluoroethylene membrane. No increase in pericardial drainage was found when the studied patients were compared to similar groups without the membrane. There were a total of 17 deaths (17.7%): group I, 1/35 (2.8%); group II, 9/41 (21.9%); and group III, 7/20 (35%). None of the deaths could be attributed to placement of the polytetrafluorethylene membrane. Seven patients had a second operation, which made possible the in vivo evaluation of the membrane. In addition, there was one late death, which allowed an autopsy. Findings were similar in all eight. There were no adhesions between the chest wall and the membrane. The latter had basically become transparent and was loosely attached to the epicardium. On the epicardial surface there was a thin layer of collagenous fibrous tissue that did not interfere with the visualization of the heart anatomy, including the coronary vessels. At early postoperative follow-up, difficulty in evaluation of the patient by two-dimensional echocardiography was encountered only in the parasternal view, but not in the other scans. In the parasternal view, the membrane is between the echo transducer and the heart and there is moderate blurring of finer details of the cardiac architecture. At late postoperative ultrasound study, resolution of the images in the parasternal views is much better. The following conclusions were reached: (1) Polytetrafluorethylene surgical membrane can be used for pericardial closure; (2) reoperation shows no adhesions to the chest wall or epicardium, and visualization of the cardiac surface, especially of the coronary vessels, is not obscured; (3) the membrane causes some difficulty in the echocardiographic examination of patients in the parasternal views, but other views allow for a complete postoperative evaluation of the heart.

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