Thorac Cardiovasc Surg
DOI: 10.1055/a-2202-4154
Original Thoracic

Long-Term Outcome of Chest Wall and Diaphragm Repair with Biological Materials

Hayan Merhej
1   Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
Mohammed Ali
1   Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
Tomoyuki Nakagiri
1   Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
Norman Zinne
2   Department of Cardiothoracic, Transplantation and Vascular Surgery, Medizinische Hochschule Hannover Zentrum Chirurgie, Hannover, Germany
Alaa Selman
1   Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
Heiko Golpon
3   Department of Pneumology and Respiratory Medicine, Hannover Medical School, Hannover, Germany
Tobias Goecke
1   Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
Patrick Zardo
1   Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
› Author Affiliations
Funding This study was funded exclusively by departmental resources.


Introduction Chest wall and/or diaphragm reconstruction aims to preserve, restore, or improve respiratory function; conserve anatomical cavities; and upkeep postural and upper extremity support. This can be achieved by utilizing a wide range of different grafts made of synthetic, biological, autologous, or bioartificial materials. We aim to review our experience with decellularized bovine pericardium as graft in the past decade.

Patients and Methods We conducted a retrospective analysis of patients who underwent surgical chest wall and/or diaphragm repair with decellularized bovine pericardium between January 1, 2012 and January 13, 2022 at our institution. All records were screened for patient characteristics, intra-/postoperative complications, chest tube and analgesic therapy duration, length of hospital stay, presence or absence of redo procedures, as well as morbidity and 30-day mortality. We then looked for correlations between implanted graft size and postoperative complications and gathered further follow-up information at least 2 months after surgery.

Results A total of 71 patients either underwent isolated chest wall (n = 51), diaphragm (n = 12), or pericardial (n = 4) resection and reconstruction or a combination thereof. No mortality was recorded within the first 30 days. Major morbidity occurred in 12 patients, comprising secondary respiratory failure requiring bronchoscopy and invasive ventilation in 8 patients and secondary infections and delayed wound healing requiring patch removal in 4 patients. There was no correlation between the extensiveness of the procedure and extubation timing (chi-squared test, p = 0.44) or onset of respiratory failure (p = 0.27).

Conclusion A previously demonstrated general viability of biological materials for various reconstructive procedures appears to be supported by our long-term results.

Data Availability Statement

The data underlying this article are available with the corresponding author and will be shared on reasonable request.

Publication History

Received: 11 July 2023

Accepted: 31 October 2023

Accepted Manuscript online:
01 November 2023

Article published online:
21 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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