CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
102
AFRICA
There were statistically significant differences between the
Ankaferd and control groups in terms of the adhesion score
[Ankaferd vs control group: 3 (2–4) vs 2 (1–3),
p
=
0.007] (Fig.
2). There was no statistically significant difference between the
Ankaferd and control group in terms of the visibility of coronary
vessels score [Ankaferd vs control group: 1 (1–2) vs 1 (1–2),
p
=
0.105] (Table 1). When the prevalence of pericardial adhesion
was compared, there was a positive trend in the odds ratio for
severe to very severe adhesion in the Ankaferd group (Ankaferd
vs control group: 87.5 vs 25%, respectively) (Table 2). When
the groups were compared according to the degree of pericardial
adhesions and the visibility of coronary vessels score, there were
statistically significant differences between the Ankaferd and
control group (
p
=
0.009,
p
=
0.033, respectively) (Table 2).
In our study, there was no infection or delayed healing at
the wound site. Results of the macro- and microscopic scores and distribution of the scores between the control and Ankaferd
groups are shown in Tables 1 and 2.
Microscopic findings
There were no statistically significant differences between the
Ankaferd and control groups in terms of severity of fibrosis
(
p
=
0.234) (Table 1). However, severe fibrosis was present in
100% of the Ankaferd group and 62.5% of the control group.
When the groups were compared according to the prevalence
of fibrosis and degree of inflammation, statistically significant
differences between the groups were found in the Ankaferd
group only in terms of the prevalence of fibrosis (
p
=
0.028)
(Fig. 3A, B). There were no statistically significant differences
between the Ankaferd and control group with regard to degree of
inflammation (
p
=
0.220) (Fig. 4A, B) (Table 2).
Discussion
One of the primary long-term postoperative concerns after a
sternotomy is the formation of pericardial adhesions during
the healing process. These adhesions are an important cause
of morbidity and mortality in cardiac surgery.
16
Pericardial
adhesions may attach the heart to the undersurface of the sternum
and neighboring structures, compromise right ventricular
Fig. 1.
A. Two weeks after the initial operation, adhesion
formation in the control group was significantly lower
between the epicardial and pericardial surfaces. This
was determined as being more easily dissected. B.
Severe pericardial adhesions, which were difficult to
dissect out, were observed between the epicardium
and mediastinal tissues in the Ankaferd group.
A
B
4
3
2
1
0
Ankaferd
Control
Groups
Pericardial adhesion score
p
=
0.007
Fig. 2.
Differences in pericardial adhesion score between the
two groups.
Table 1. Results of macroscopic and microscopic scores
between the control and Ankaferd groups.
Variables
Ankaferd
group
(
n
=
8)
Median
(range)
Control
group
(
n
=
8)
Median
(range)
Z
p
Macroscopic scores
Pericardial adhesions
3 (2–4)
2 (1–3) 2.680 0.007
Visibility of coronary vessels 2 (1–2)
1 (1–2) 2.000 0.105 (NS)
Microscopic scores
Inflammation
2 (2–3)
3 (1–3) 1.061 0.382 (NS)
Fibrosis
3 (3–3)
3 (1–3) 1.852 0.234 (NS)
NS, not statistically significant (
p
>
0.05).
