Germination of a cardiac shirt by a tumor or its metastases requires its wide excision. The resulting defect in the wall of the pericardium, especially after performing pneumonectomy, creates the prerequisites for the development of a severe complication, the “dislocation” of the heart into the pleural cavity with a sharp disruption of its activity. After extensive resections of the pericardium, it is rarely possible to suture the defect. More often it is necessary to resort to its plastic closure. Many methods of pericardial plasty have been proposed. The most commonly used flap is the parietal pleura, taken on the pedicle or loosely along with the intrathoracic fascia, near pericardial fatty tissue. However, they are mechanically unstable and far from always after extensive surgical interventions, it is possible to carve out a sufficiently large area of the parietal pleura or adipose tissue to close the pericardial defect that has formed. The use of alloplastic materials for this purpose is much more convenient and reliable.
Since 1981, the clinic for alloplasty of the pericardium after its resection applies the Bulgarian antibacterial polycaproamide mesh “Ampoxen” (BAPP), created in 1976 at the suggestion of Professor N. Vasilev by a team of staff led by Professor K. Dimov. The mesh is made of polyfilament fibers with a thickness of 20— micron, the size of the cells is 1– mm. The antibacterial effect is achieved by creating a special chemical bond between the polymer and the medicinal substance, which may include various antibiotics and antiseptics. BAPP has strength, optimal elasticity, does not allergize the body, does not have a blastomogenic effect, has chemical and biological inertness, hemostatic properties.
To study the fate of the implant and the reaction to it of the surrounding tissues, we conducted 29 experimental studies on dogs on pericardial plasty of BAPP. After performing pneumonectomy 14 animals on the right and 15 left portion resect pericardial area 10 cm 2 and a plastic formed Bappoo defect. Animals were removed from the experiment in terms of 1.6, 8, 11, 14 days, 1 and 2 months, 1 year, followed by macroscopic and histological examination of the preparations.
It was found that in the tissues immediately adjacent to the grid, a regular change of the phases of inflammation is found: unexpressed alterative
phenomena in the adjacent epicardium in 1– day, accompanied by loss of fibrin on the grid, are replaced by a picture of alterative-infiltrative inflammation in the subepicardial myocardial layers with the formation of adhesions in 3 – day. Further, proliferative changes in the area of plastics and tissue contact with the implant, which are manifested by the formation of a connective tissue scar, are progressing. In the long-term (up to 1 year) full grid resorption does not occur.
Thus, the Bulgarian anti-bacterial polycaproamide mesh “Ampoxen” is a good plastic material for closing defects when performing advanced combined operations for lung cancer with resection of the pericardium. The resulting inflammatory response of the tissues to the implant is not pronounced and is local, does not cause progressive pericarditis. Subsequently, partial resorption of the mesh occurs with the formation of a soft connective tissue scar at the point of contact of the heart with a plastic material that does not impede the work of the heart.
BAPP “Ampoxen” was applied to plastics of pericardial defects in 61 patients when performing advanced combined resections for lung cancer. In none of the patients, we noted the development of complications in the postoperative period, which could be associated with the use of the mesh. To our opinion, BAPP “Ampoxen” is a convenient, reliable and safe material for alloplasty of pericardial defects after its extensive resection.
The second most common type of vascular atrial resection is the resection of the pulmonary veins with a section of the left atrium. Among our patients, they were performed in 64 patients, which accounted for 15.1% of patients who underwent resection of the vascular-atrial type and 10.6% of all operated on patients who underwent combined operations.
Resection of the pulmonary veins with atria is equally often performed in right- and left-sided lesions of the lungs. The need for their implementation arises in patients with far-reaching local spread of the tumor, characterized by extensiveness and multiplicity of lesions of various extrapulmonary anatomical structures and organs of the thoracic cavity. Therefore, they tend to be multiple, often combined. Such surgical interventions are traumatic, increased risk of severe intraoperative complications.