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

Bob P Hermans; Wilson W L Li; Edwin A Roozen; Daniël I M van Dort; Jort Evers; Erik H F M van der Heijden; Stefan M van der Heide; Harry van Goor; Ad F T M Verhagen

doi:10.21037/jtd-22-1821

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

J Thorac Dis. 2023 Jul 31;15(7):3580-3592. doi: 10.21037/jtd-22-1821. Epub 2023 Jul 10.

Authors

Bob P Hermans¹, Wilson W L Li¹, Edwin A Roozen², Daniël I M van Dort¹, Jort Evers¹, Erik H F M van der Heijden³, Stefan M van der Heide¹, Harry van Goor², Ad F T M Verhagen¹

Affiliations

¹ Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
² Department of General Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
³ Department of Pulmonology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.

Abstract

Background: 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.

Methods: GATT-Patch Single/Double layers were compared to Progel^®, Coseal^®, Hemopatch^® and TachoSil^® in an ex vivo 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 cmH₂O): (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.

Results: Per sealant 10 measurements were performed (both experiments). In the first experiment, BP was superior for GATT-Patch Double (60±24 cmH₂O) compared to TachoSil^® (30±11 cmH₂O, P<0.001), Hemopatch^® (33±6 cmH₂O, P=0.006), Coseal^® (25±13 cmH₂O, P=0.001) and Progel^® (33±11 cmH₂O, 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 vs. 40±6 cmH₂O, P=0.043) and AL-reduction (100%±11% vs. 68%±40%, P=0.043) when compared to Hemopatch^®.

Conclusions: The novel NHS-POx patch shows promise as a lung sealant, demonstrating elevated BP, good adhesive strength and a superior AL-reduction.

Keywords: Air leak; biomaterials; ex vivo; experimental; lung sealant; lung surgery.