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Ann Thorac Surg 1999;67:1209
© 1999 The Society of Thoracic Surgeons

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Correspondence

Absence of GRF glue effect two years after aortic repair

^a Cardiothoracic Surgery Department, Walsgrave Hospital, Clifford Bridge Road, Coventry, CV2 2DX United Kingdom

To the Editor

A 73-year-old hypertensive lady presented in October 1996 with acute chest pain and no history of angina. Acute aortic dissection was suspected on clinical grounds and computed tomographic scan confirmed the presence of type A aortic dissection.

She had an emergency operation, and we found classic dissection of ascending aorta with entry point 1.5 cm distal to the sinotubular junction. She had ascending aortic replacement with resuspension of native aortic valve using right atriofemoral bypass and deep hypothermia.

We used GRF glue to obliterate the false lumen and resuspended the native commissures using mersylene sutures. A 34-mm vascutex graft was sutured in place. On completion of the proximal anastomosis, cardioplegia was delivered to the graft, which confirmed suture line integrity and valve competence. We used an open technique to perform the distal anastomosis, once again using GRF glue to obliterate the false lumen. The patient was weaned from cardiopulmonary bypass without difficulty and remained well for more than a year.

She recently complained of progressive shortness of breath, which resulted in paroxysmal nocturnal dyspnea as well as orthopnea. Examination revealed moderate ankle edema, elevated JVP, and signs of severe aortic regurgitation. Aortography revealed severe aortic regurgitation with prolapse of the noncoronary cusp. In addition, there was a false aneurysm occupying the right side of the aorta, originating from the area of the noncoronary cusp. She had depressed ventricular function and near-normal coronary anatomy.

She underwent reoperation; right atriofemoral bypass was established. Her heart was arrested using cold crystalloid cardioplegia and deep systemic hypothermia. A false aneurysm was identified in the area of the noncoronary cusp, with disruption of the previous graft at that point. Close examination of the commissure revealed no evidence of glue or tissue healing. There was no fibrosis in the false lumen around the dissected aortic valve. The distal anastomosis appeared tenuous, and we decided to replace the whole of the ascending aorta. Once we cut the sutures that were used to construct the distal anastomosis, we noted that the vascutex graft, the adventitial layer, and the intima were held together only by the suture. There was no evidence of glue, fibrosis, or tissue healing.

We believe that GRF glue is helpful in leathering the fragile tissues in aortic dissection, which helps the application of sutures into firmer tissues. However, it is disturbing to note that tissue healing, fibrosis, or even adventitial union did not take place in the long term.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael D. Rosin Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bassiony, A. A. Articles by Rosin, M. D. Search for Related Content PubMed Articles by Bassiony, A. A. Articles by Rosin, M. D.