| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ann Thorac Surg 2007;83:1626-1627
© 2007 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, Baylor College of Medicine, Cardiovascular Surgery Service, The Texas Heart Institute at St. Luke’s Episcopal Hospital, One Baylor Plaza, BCM 390, Houston, TX 77030
(Email: slemaire{at}bcm.edu).
In this report, Hata and colleagues [1] describe the incidence and treatment of pseudoaneurysms that developed after repairing ascending aortic dissections with gelatin-resorcinol-formaldehyde (GRF) glue. This aldehyde-based adhesive, also known as "French glue," has excellent bonding strength and has been particularly useful for reapproximating the layers of the dissected aorta, reinforcing weakened aortic tissue, and improving anastomotic hemostasis. Although GRF glue is widely used in Europe and Asia, concerns about toxicity have prevented its approval for use in the United States.
The authors describe 68 patients who underwent repair of acute ascending aortic dissection during nearly an 11-year period; GRF glue was used in 56 of the cases (82%). Adverse outcomes included bleeding requiring reoperation in 7 patients (10%), stroke in 5 (7%), and early mortality in 8 (12%). The 60 surviving patients were followed-up with semi-annual imaging studies that detected anastomotic pseudoaneurysms in 5 patients (8%) after an average interval of 36 months after repair. Notably, all 5 patients who had pseudoaneurysms develop underwent successful reoperation.
Although the authors carefully emphasize that theirs was not intended to be "a comparative study," their data are meant to support concerns about the association between GRF glue and late anastomotic complications. The authors report that in all 5 patients with pseudoaneurysms, "GRF glue was used during the initial aortic operation. In contrast, no pseudoaneurysms were observed in any of the patients treated without GRF glue." However, it is important to emphasize that this difference in clinical outcome was very probably due to chance (p = 0.6; according to a two-tailed Fisher exact test), and thus it provides limited support for an association between GRF glue and pseudoaneurysm formation at best. Nevertheless, histologic examination revealed signs of aortic inflammation, degeneration, and necrosis associated with the foreign material at the anastomotic sites.
Despite its descriptive nature, the current report is an important addition to the expanding literature on the potential toxicities of surgical adhesives. As the authors point out, several previous reports have described necrotic, fibrosed, and excessively thinned aortic tissue at the site of adhesive application, and have suggested that GRF glue can injure aortic tissue, ultimately leading to redissection or pseudoaneurysm formation. Citing these data and their own evolving experience, the authors appropriately emphasize the need for caution when using GRF glue, as well as careful follow-up to enable early detection of complications. This report is particularly relevant now that there is a widely available alternative to GRF glue (ie, BioGlue surgical adhesive [CryoLife, Inc, Kennesaw, GA], which is an aldehyde-based glue composed of bovine albumin and glutaraldehyde) that is being used in a wide array of surgical procedures. Several anecdotal reports have documented severe inflammation, aortic necrosis, and pseudoaneurysm formation after BioGlue was used during aortic repairs [2–5]; whether these problems will continue to surface remains to be seen.
The mounting concerns about aldehyde-based adhesives have recently led some highly regarded aortic surgeons to stop using these agents altogether [6, 7]. Many others, including Hata and colleagues [1], continue to use these agents but emphasize the importance of proper application techniques and judicious use [4, 5, 8]. Using these adhesives selectively and sparingly seems to be the key to enjoying their benefits while minimizing their well-documented risks. Given these risks, the routine use of surgical adhesives during cardiovascular operations can not be recommended; however, during certain complex procedures, especially in cases of acute aortic dissection, the benefits of using these agents may truly outweigh the risks. In the ongoing effort to clarify these risks and improve the safety of using surgical adhesives, recognizing and reporting potential complications, as exemplified by Hata and colleagues’ contribution, remains essential.
 |
References |
|---|
 Top References |
|---|
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
