The Importance of Fibrin Sealing in the Development of Surgical Treatment of Aneurysms of the Aortic Root


The history of surgical treatment of aortic aneurysms demonstrates, on the one hand, that therapeutic concepts have been experimentally developed long before they could be realized clinically, and, on the other, that old procedures are generally still important in addition to modern therapies. Composite graft replacement of the aortic root is the last technical improvement of replacement procedures. It is followed only by an improvement in hemostasis, especially by using Fibrin glue (Tissucol Duo S, human fibrinogen, human thrombin, steam treated) and gelatine-resorcine-formol glue (GRF). The operative results in 128 patients with aneurysms of the ascending aorta who underwent surgery between 1973 and 1992 in Tübingen and Bad Nauheim demonstrate the change in therapeutic concepts. Besides several variations in supracoronary replacement of the ascending aorta, composite graft replacement has been used increasingly in recent years, since more than 50% of patients undergoing supracoronary replacement simultaneously received aortic valve replacement (AVR). Fibrin glue for sealing high-porosity prostheses and suture lines has been used routinely since 1982, and GRF glue since 1989 for gluing dissections in spite of anticoagulation. In patients with composite graft replacement and fibrin sealing and GRF gluing a markedly diminished postoperative blood loss of 780 ml was found, in contrast to 1130 ml. The considerably higher early mortality of 30.2% among patients with supracoronary replacement of the ascending aorta is caused partly (7 of 19 cases) by problems occurring in the proximal anastomotic region. Following supracoronary replacement of the ascending aorta ten patients underwent reoperation, on the average 3.5 years after the first operation. On the basis of these experiences the indication for composite graft replacement of the aortic root can be recommended in most cases of aneurysms of the ascending aorta. The basic degenerative disease affects the entire root of the aorta. More than 50% of patients undergoing supracoronary replacement of the ascending aorta primarly have even AVR. Supracoronary replacement of the ascending aorta is characterized by a high reoperation rate for secondary aortic valve incompetences and aneurysms of the aortic root. Early mortality in patients with composite graft replacement of the aortic root is even lower than that in patients with supracoronary replacement of the ascending aorta. Sealing procedures with fibrin glue and GRF reduce postoperative blood loss and bleeding-related early mortality.


Aortic Valve Aortic Aneurysm Aortic Root Aortic Valve Replacement Fibrin Glue 
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© Springer-Verlag Berlin Heidelberg 1995

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  • C. Huth

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