Sealing effectiveness of a novel NHS-POx based patch: experiments in a dynamic ex vivo porcine lung

• Published in: Journal of thoracic disease Vol. 15; no. 7; pp. 3580 - 3592
• Main Authors: Hermans, Bob P, Li, Wilson W L, Roozen, Edwin A, van Dort, Daniël I M, Evers, Jort, van der Heijden, Erik H F M, van der Heide, Stefan M, van Goor, Harry, Verhagen, Ad F T M
• Format: Journal Article
• Language: English
• Published: China AME Publishing Company 31.07.2023
• Subjects: Original; Air leak; lung surgery; experimental; biomaterials; ex vivo; lung sealant
• ISSN: 2072-1439; 2077-6624
• DOI: 10.21037/jtd-22-1821

Sealants are used to prevent prolonged pulmonary air leakage (PAL) after lung resections (incidence 5.6-30%). However, clinical evidence to support sealant use is insufficient, with an unmet need for a more effective product. We compared a novel gelatin patch impregnated with functionalized polyoxazolines (NHS-POx) (GATT-Patch) to commercially available sealant products. GATT-Patch Single/Double layers were compared to Progel , Coseal , Hemopatch and TachoSil in an porcine lung model (first experiment). Based on these results, a second head-to-head comparison between GATT-Patch Single and Hemopatch was performed. Air leakage (AL) was assessed in three settings using increasing ventilatory pressures (max =70 cmH O): (I) baseline, (II) with 25 mm × 25 mm superficial pleural defect, and (III) after sealant application. Lungs floating on saline (37 ℃) were video recorded for visual AL assessment. Pressure and tidal volumes were collected from the ventilator, and bursting pressure (BP), AL and AL-reduction were determined. Per sealant 10 measurements were performed (both experiments). In the first experiment, BP was superior for GATT-Patch Double (60±24 cmH O) compared to TachoSil (30±11 cmH O, P<0.001), Hemopatch (33±6 cmH O, P=0.006), Coseal (25±13 cmH O, P=0.001) and Progel (33±11 cmH O, P=0.005). AL-reduction was superior for GATT-Patch Double (100%±1%) compared to Hemopatch (46%±50%, P=0.010) and TachoSil (31%±29%, P<0.001), and also for GATT-Patch Single (100%±14%, P=0.004) and Progel (89%±40%, P=0.027) compared to TachoSil . In the second experiment, GATT-Patch Single was superior regarding BP (45±10 40±6 cmH O, P=0.043) and AL-reduction (100%±11% 68%±40%, P=0.043) when compared to Hemopatch . The novel NHS-POx patch shows promise as a lung sealant, demonstrating elevated BP, good adhesive strength and a superior AL-reduction.