Off pump epicardial tissue sealing – A novel method for the treatment of atrio-ventricular disruption complicating mitral valve procedures

Objectives: Atrio-ventricular (AV) disruption is a rare but life threatening complication after mitral valve procedures. Even with immediate intrracardiac repair a 90% mortality rate is associated with AV-disruption as a result of untreatable bleeding complications, mass transfusions and tamponade. We investigated a novel approach of epicardial sealing off pump using a biodegradable collagen-system with fibrinogen-based coating (Tachocomb) on 1 year survival in humans with AV disruption.

Material and Methods: Between May 1998 and April 2002 a total of 9 patients (1.2% of all mitral valve procedures performed) presented with intraoperative AV disruption. The first 4 patients were treated with intracardiac repair on cardiopulmonary bypass. The other 5 patients were treated with epicardial sealing using layers of Tachocomb off pumnp and after protamine administration. During repair a cell saver was used to reduce blood loss.

Results: In the first group 3 patients (75%) died within the first 30 days following AV disruption, 2 intraoperative due to bleeding and 1 on ICU secondary to mass transfusion. In the second group all 5 patients (100%) survived and remained free of symptoms at 1 year follow up. The amount of packed cells transfused was lower in the tissue sealing group (4.6±1.3 vs. 15.4±4.8, p<.05).

Conclusions: This is the first series of epicardial tissue sealing using a biodegradable collagen-system with fibrinogen-based coating as a novel and highly successful method for acute AV disruption when compared to intracardiac repair. Because of our results we have changed our policy for the treatment of acute AV disruption.