Chitosan as a Post-Pericardiotomy epicardial anti-adhesion Material in animal model, Rabbits (Oryctolaguscuniculus)

Abstract

Epicardial adhesion is a common clinical condition in cardiac re-surgery that complicates the bypass or open-heart surgery procedures, prolongs the time of surgery, and causes the surgical bleeding and organ damages. One of the potentials, yet controversial materials, chitosan, is reported to be an effective anti-adhesion agent. Chitosan is a strong bio-anti-adhesion and naturally degraded.The aim of this study was to investigate the potential role of chitosan as epicardialanti-adhesion in post-pericardiotomy in animal model, rabbit (Oryctolagus cuniculus).Sevenanimalsfor each treatmentand control group were used. The treatment group was given 2% chitosan solution while the control groupwas given normal saline.All rabbits werethen later provided withstandard postoperative care and a re-sternotomy was performed at the day6postoperative to assess the adhesion.Both macroscopic and microscopic adhesion parameters were assessed. The degree of the macroscopic adhesion was evaluated using the adhesion tenacity scores. The microscopic adhesion was evaluated by the number of fibroblasts and the connective tissue thickness formed on the surface of the epicardium. The adhesion tenacity scores and the connective tissue thickness were compared with a non-parametric method using the Mann-Whitney test. The number of fibroblasts was compared using independent samples t-test. Our data suggested that the adhesion tenacity scoreswas lower in treatment group compared to control group (mean rank 5.2vs. 9.7, p=0.026). The number of fibroblasts were significantly lower in treatment group compared to control group (mean rank 23.4vs. 93.0, p=0.006) and the connective tissue was significantly thinner in treatment group than control group(mean rank 5.0vs. 10.0, p=0.025). In conclusion, chitosan significantlyinhibited the level of epicardium adhesion after pericardiotomy in rabbits.