A novel synthetic sealant to treat air leaks at cardiac reoperation

Purpose: Pulmonary injury with resultant air leak is common at cardiac reoperation. Sequelae of this complication include prolonged chest tube drainage and time to ambulation, extended hospitalization and increased costs, and mediastinitis. The purpose of this study was to test the efficacy of a new synthetic absorbable sealant at treatment air leaks occurring at cardiac reoperation. Patients and Methods: Fifteen patients having cardiac reoperation had lung injuries repaired with FocaISeal-L Sealant (Focal, Inc., Lexington, MA). Mean age was 61 +/- 15 years, and mean interval from the previous to the current operation was 44 +/- 38 months. Results: In all patients, FocaISeal-L Sealant was successful at sealing intraoperative air leaks. Postoperatively, 73% of patients had no air leak. Four patients (27%) developed a recurrent air leak, three on postoperative day 1 and one on postoperative day 2. In three of these patients, the air leak sealed within 3 days. In the fourth patient, an immunosuppressed heart transplant recipient with mediastinitis, the air leak never sealed; that patient died of sepsis after an omental flap failed to control the air leak. In patients without air leak, chest tubes were removed on postoperative day 1 (9 patients) or 2 (1 patient). Conclusion: This novel synthetic sealant prevents postoperative air leaks in the majority of patients suffering lung injury at cardiac reoperation.