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Kasahara and Hayashi Journal of Cardiothoracic Surgery 2014, 9:121 http://www.cardiothoracicsurgery.org/content/9/1/RESEARCH ARTICLEOpen AccessPolyglycolic acid sheet with fibrin glue potentiates the effect of a fibrin-based haemostat in cardiac surgeryHirofumi Kasahara* and Ichiro HayashiAbstractBackground: Hemorrhage from the left ventricle can be critical and sutureless repair using a fibrin-based haemostat (TachoComb) is one effective option. When 2,4-Diphenyl-6-[4-(4,4,5,5-tetramethyl-1,3,2-dioxaborolan-2-yl)phenyl]-1,3,5-triazine active hemorrhage is not controlled by the haemostat, we have used a polyglycolic acid (PGA) sheet and fibrin glue in addition. Here we investigated whether the PGA sheet and fibrin glue combined with TachoComb had stronger adhesive properties than TachoComb alone in two experimental models. Methods: Experiment 1. An airtight Methyl 3-fluoro-2-thiophenecarboxylate circuit that included rabbit skin with holes covered by each type of sealant was gradually pressurized and the burst pressure was recorded automatically (n = 10). Experiment 2. A suture loop was attached to a porcine heart by each sealant, and the peel-off pressure was measured (n = 12). Results: The PGA sheet and fibrin glue combined with TachoComb showed significantly higher adhesive strength than TachoComb alone in both experiments (p < 0.05). Conclusions: Adding a PGA sheet and fibrin glue increased the adhesive strength of TachoComb in two experimental models, suggesting that this method might be effective for achieving haemostasis in difficult clinical situations. Keywords: Polyglycolic acid sheet, TachoComb, Hemorrhage, Left ventricleBackground Active hemorrhage from a ventricle is potentially catastrophic. Critical left ventricular (LV) wall injury can be caused by myocardial infarction, catheter intervention, cardiac surgery, or trauma. Recent changing trends in the population at risk have resulted in an increasing number of high-risk patients undergoing coronary intervention and cardiac surgery, leading to a potential increase in the risk of such complications. Sutureless repair methods have been reported for ventricular injury, especially using TachoComb (TC) or TachoSil, which are biodegradable collagen patches with a fibrinogen/thrombin-based coating. In severe cases, such as active bleeding from the left ventricle or LV free wall rupture, we have applied a polyglycolic acid (PGA) mesh sheet with fibrin glue in addition to TC in order to achieve stronger* Correspondence: kasa7777@gmail.com Department of Cardiovascular Surgery, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako 351-0102, Japanadhesion, and we have the clinical impression that this method is often effective even in dire situations. Polyglycolic acid is gradually degraded PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/13867361 by hydrolysis and slowly loses strength in vivo, and it is currently used to make absorbable surgical sutures. Polyglycolic acid mesh sheet is a soft nonwoven fabric known for its flexibility, elasticity, and low cost, which is available in the EU countries and Japan for clinical use as an absorbable reinforcing material. Since PGA itself is not adhesive, fibrin glue is usually combined PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/11834444 with PGA sheets for surgical use. There have been many reports about the use of PGA sheets with fibrin glue for the treatment of lung injury or pulmonary artery damage in the field of thoracic surgery [1,2]. However, there have been no reports concerning PGA sheets as a haemostatic material for cardiac surgery to our knowledge.?2014 Ka.