CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
100
AFRICA
Assessment of the efficacy of Ankaferd blood stopper
on the prevention of postoperative pericardial adhesions
Yunus Nazli, Necmettin Colak, Mehmet Fatih Alpay, Hacer Haltas, Omer Nuri Aksoy, Ismail Olgun
Akkaya, Omer Cakir
Abstract
Objectives:
Ankaferd has been used as a blood-stopping
agent and it may also have an anti-inflammatory effect. We
investigated the efficacy of Ankaferd in preventing postopera-
tive pericardial adhesions in an experimental rabbit model.
Methods:
Sixteen New Zealand white rabbits were used and
categorised into two groups: an Ankaferd and a control group.
The Ankaferd group of rabbits was treated with a sponge
impregnated with Ankaferd solution, which was applied over
the abraded epicardium. A sponge impregnated with 0.9%
isotonic NaCl solution was applied to the control group using
the same protocol. Scores for adhesion and visibility of coro-
nary vessels were graded by macroscopic examination, and
pericardial tissues were analysed microscopically in terms of
inflammation and fibrosis.
Results:
In the Ankaferd group, the adhesion scores were
significantly higher than in the control group (
p
=
0.007).
When the groups were compared according to the prevalence
of fibrosis and degree of inflammation, the Ankaferd group
was found to be statistically significantly different from the
control group in terms of prevalence of fibrosis (
p
=
0.028).
Conclusion:
Topical application of Ankaferd to prevent
postoperative pericardial adhesions increased adhesion and
fibrosis scores.
Keywords:
cardiac operation, Ankaferd, pericardial adhesion
Submitted 6/2/14, accepted 20/2/14
Cardiovasc J Afr
2014;
25
: 100–105
DOI: 10.5830/CVJA-2014-011
Postoperative pericardial adhesion formation occurs frequently
after cardiac surgery and is an important cause of morbidity and
mortality at the time of re-operation. As the number of patients
undergoing cardiac surgery continues to increase, the number of
potential candidates for re-operation is increasing exponentially.
Despite ongoing improvements during cardiac re-operation
surgery, the presence of pericardial adhesions not only adds to
the surgery time but also increases the risk of life-threatening
injuries to the heart, great vessels or previously placed coronary
bypass conduits by obscuring the true anatomy.
1
Various methods and materials have been investigated to
prevent or reduce the severity of postoperative adhesions in
the retrosternal spaces and mediastinal structures. Fibrinolytic
agents, histamine antagonists, anti-coagulants, anti-inflammatory
drugs (corticosteroids, non-steroidal drugs), antibiotics, several
natural physical barriers (heterologous pericardium, omentum,
peritoneum, amnion, fibrin, gelatin, collagen and hyaluronic
acid) and synthetic physical barriers (rubber, silicon-based
materials, cellulose, polytetrafluoroethylene, polyvinyl alcohol
and polyester derivatives) have been tried with variable success
for such purposes.
2-6
Unfortunately, despite continuous advances
and research, to date there is no ideal method to prevent or
reduce postoperative pericardial adhesion formation.
Ankaferd blood stopper
®
(ABS) (Ankaferd Ilac Kozmetik AS,
Istanbul, Turkey) is a folkloric medicinal plant extract. Ankaferd
has been used as a blood-stopping agent against various types
of bleeding. It has been approved by the Ministry of Health
in Turkey for the management of bleeds due to external injury
and dental surgery. It has also been used as a topical agent
for the prevention of postoperative intra-abdominal fibrosis in
experimental studies, and variable results have been obtained.
7,8
To the best of our knowledge, there is no report on the effect
of Ankaferd in preventing postoperative pericardial adhesions to
date. The present experimental study was designed to investigate
the effect of intrapericardially administeredAnkaferd on reducing
postoperative pericardial adhesion formation in the rabbit model.
Methods
The study protocol was approved by the Ethics Committee for
Animal Research, Ankara Education and Research Hospital,
Ankara, Turkey. Sixteen New Zealand white rabbits weighing 2.5
to 3.0 kg were anesthetised with 35 mg/kg ketamine hydrocloride
and 5 mg/kg xylazine administered intramuscularly.
9,10
After
disappearance of the pedal reflex in the hind limbs, the rabbits
were placed in the supine position on a heated operating table
and their temperature was maintained at 39°C by monitoring
their rectal temperature.
11,12
The pedal reflex was checked every
five minutes throughout the surgical procedure.
A venous line was established in the ear and a saline solution
was infused at a rate of 3 mg/kg/h. Prophylactic antibiotic
(cefazolin sodium 40 mg/kg) was given intravenously just before
the operation. All had continuous two-lead electrocardiograph
monitoring during the surgery. A paediatric facial mask in which
oxygen gas flowed at a rate of 200 ml/min was placed on each
rabbit.
13
Department of Cardiovascular Surgery, University of
Turgut Ozal, Ankara, Turkey
Yunus Nazli, MD,
Necmettin Colak, MD
Mehmet Fatih Alpay, MD
Omer Nuri Aksoy, MD
Ismail Olgun Akkaya, MD
Omer Cakir, MD
Department of Pathology, University of Turgut Ozal,
Ankara, Turkey
Hacer Haltas, MD
