Prevention of Air Leakage by Spraying Vivostat Fibrin Sealant After Lung Resection in Pigs* Henrik K. Kjaergard 1 , MD; Jesper Holst Pedersen 1 , MD; Mark Krasnik 1 , MD; Ulla S. Weis-Fogh 2 , MS; Hanne Fleron 1 , RN; and H. Eugene Griffin 2 , DVM, MS Study objectives: To evaluate Vivostat fibrin sealant in the prevention of air leakage after experimental lung resection in pigs. Design: Randomized study. Setting: University laboratory. Methods: Six Landrace pigs were operated on in both lungs through a median sternotomy. Five different resection sites were created in each lung. Intervention: Randomization was performed to either application of Vivostat fibrin sealant (ConvaTec; Skillman NJ) or human albumin 20% (control) at the resection sites. The lung parenchyma was occluded with a soft clamp for either 1, 2, 5, or 10 min in the treatment group and 10 min in the control group. After removal of the clamp, the lung was ventilated with an increasing intrabronchial pressure of 20, 30, and 45 cm H 2 O for 2 min at each step. Results: At inspiratory pressures of 20 and 30 cm H 2 O air leaks were found in the control group but not in the Vivostat group (p < 0.001). At an inspiratory pressure of 45 cm H 2 O, there were two small air leaks in the Vivostat group at each clamping time (four at 5 min), compared with five small and seven large leaks in the control group. Analysis of the data after 10 min of clamping showed that the Vivostat group was superior to the human albumin group (p  0.002). Conclusions: This randomized study shows that Vivostat fibrin sealant is effective in preventing air leakage after small lung resections in pigs, even at high inspiratory pressures. (CHEST 2000; 117:1124 –1127) Key words: autologous; complications; fibrin sealant; lung resection; pulmonary air leak P ostoperative air leakage is the most frequent complication after lung surgery, regardless of whether an operation is performed by thoracotomy or by use of endoscopic techniques. A persistent air leak increases the incidence of morbidity and pro- longs patient hospitalization, incurring additional expenses. 1 Therefore, expectations are high for the many new types of surgical sealants for pulmonary air leakage that have emerged in the last decade. The aim of this randomized study was to study the effectiveness of a new, autologous fibrin sealant, Vivostat (ConvaTec; Skillman NJ), on air leaks after experimental lung resection in pigs. In addition, the optimal conditions for use of the sealant were stud- ied, as well as its efficacy during high positive ventilation pressure (to simulate coughing). Materials and Methods Fibrin Sealant Production The Vivostat system is a medical device for the preparation of an autologous fibrin sealant from 120 mL of the patient’s blood in the operating theater. 2 The system is fully automated and microprocessor-controlled, and is made up of three components: an automated processor unit, an automated applicator unit, and a disposable, single-patient-use unit, which includes a preparation set and a Spraypen applicator (Fig 1). To produce the sealant, 120 mL of the patient’s blood is drawn into the preparation set and mixed with 17 mL of 4% trisodium citrate USP for anticoagulation. The preparation set is then placed into the processor, and the automated processing is begun. Rapid cycle centrifugation results in the isolation of *From the Department of Cardiothoracic Surgery (Drs. Kjaer- gard, Pedersen, Krasnik, and Fleron), Gentofte Hospital, and the Panum Institute (Drs. Weis-Fogh and Griffen), University of Copenhagen, Denmark. Financial disclosure: At the time of this study, H. Eugene Griffin, DVM, MS, was Director of Preclinical Research at ConvaTec, a Bristol-Myers Squibb Company. ConvaTec is developing the Vivostat System, and paid all study-related expenses. None of the authors received any personal payment for their participation in this study. Manuscript received May 21, 1999; revision accepted October 4, 1999. Correspondence to: Henrik K. Kjaergard, MD, Department of Cardiothoracic Surgery, Gentofte Hospital, Niels Andersens Vej 65, DK-2900 Hellerup, Denmark; e-mail: hekja@gentoftehosp. kbhamt.dk 1124 Laboratory and Animal Investigations Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21942/ on 06/21/2017