Sealing strength and application efficiency of the microbubble fibrin sealant technique: influence of PGA sheet type in an ex vivo porcine lung model.

OBJECTIVE: We previously proposed the microbubble fibrin sealant application technique (microbubble technique) for the precise and efficient delivery of fibrinogen to air leak sites. However, its sealing strength and application efficiency are still unclear. This study aimed to assess the non-inferiority of the microbubble technique in sealing strength, the influence of polyglycolic acid (PGA) sheet type, and its effect on reducing fibrin sealant runoff. METHODS: Pleural defects were created in ex vivo porcine lungs. Fibrin sealant was applied using either the conventional or microbubble technique with two types of PGA sheets. Seal-breaking pressure was measured, and the non-inferiority of the microbubble technique was assessed. The interaction between the application technique and the PGA sheet type was analyzed. In addition, the fibrin sealant runoff was evaluated on an inclined lung surface. RESULTS: Using the Neoveil® PGA sheet, the microbubble technique demonstrated seal-breaking pressure not inferior to that of the conventional technique (40.2 ± 8.4 vs. 40.9 ± 6.0 cmH2O; mean difference - 0.72 cmH2O; one-sided 95% confidence interval - 3.62 to infinity). The Neoveil® nano NJ type PGA sheet improved sealing strength with the conventional technique, but reduced it with the microbubble technique. A significant interaction between the PGA sheet type and the application technique was observed (P < 0.001). Histological analysis supported these findings. The microbubble technique significantly reduced fibrin sealant runoff (P < 0.001). CONCLUSION: The microbubble technique demonstrated sealing strength comparable to that of the conventional technique while reducing fibrin sealant runoff. However, sealing performance appeared to depend on the PGA sheet type.