Advertisement

Using BioGlue to achieve hemostasis in aortic root surgery

  • Scott A. LeMaire
  • J. S. Coselli

Abstract

Aortic root operations involve the creation of fragile suture lines that become difficult to access once the repair is complete. Furthermore, these procedures involve working with aortic tissue that is extremely fragile, especially in patients with acute aortic dissection or connective tissue disorders. Consequently, securing hemostasis during these operations remains a significant challenge. In a multicenter study of 151 patients with Marfan syndrome who underwent aortic root replacement, 9% of patients required mediastinal reexploration to treat bleeding [34]. In another recent report, the incidence of bleeding requiring reoperation was 12.9% in a series of 132 patients who underwent root replacement with porcine aortic root xenografts [25].

Keywords

Aortic Dissection Aortic Root Marfan Syndrome False Lumen Acute Aortic Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Azadani AN, Matthews PB, Ge L, Shen Y, Jhun CS, Guy TS, Tseng EE (2009) Mechanical properties of surgical glues used in aortic root replacement. Ann Thorac Surg 87:1154–1160CrossRefPubMedGoogle Scholar
  2. 2.
    Baciewicz FA Jr (2006) Mechanical aortic valve malfunction: an intraoperative BioGlue complication. J Thorac Cardiovasc Surg 131:761–762PubMedGoogle Scholar
  3. 3.
    Bavaria JE, Brinster DR, Gorman RC, Woo YJ, Gleason T, Pochettino A (2002) Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg 74:S1848–1852CrossRefPubMedGoogle Scholar
  4. 4.
    Bernabeu E, Castella M, Barriuso C, Mulet J (2005) Acute limb ischemia due to embolization of biological glue after repair of type A aortic dissection. Interact Cardiovasc Thorac Surg 4:329–331CrossRefPubMedGoogle Scholar
  5. 5.
    Bingley JA, Gardner MA, Stafford EG, Mau TK, Pohlner PG, Tam RK, Jalali H, Tesar PJ, O’Brien MF (2000) Latecomplications of tissue glues in aortic surgery. Ann Thorac Surg 69:1764–1768CrossRefPubMedGoogle Scholar
  6. 6.
    Carrel T, Maurer M, Tkebuchava T, Niederhauser U, Schneider J, Turina MI (1995) Embolization of biologic glue during repair of aortic dissection. Ann Thorac Surg 60:1118–1120CrossRefPubMedGoogle Scholar
  7. 7.
    Chao HH, Torchiana DF (2003) BioGlue: albumin/glutaraldehyde sealant in cardiac surgery. J Card Surg 18:500–503CrossRefPubMedGoogle Scholar
  8. 8.
    Chen YF, Chou SH, Chiu CC, Lin YT, Wang HJ (1994) Use of glutaraldehyde solution in the treatment of acute aortic dissections. Ann Thorac Surg 58:833–835.PubMedGoogle Scholar
  9. 9.
    Coselli JS, LeMaire SA, Köksoy C (2000) Thoracic aortic anastomoses. Oper Tech Thorac Cardiovasc Surg 5:259–276CrossRefGoogle Scholar
  10. 10.
    Coselli JS, Bavaria JE, Fehrenbacher J, Stowe CL, Macheers SK, Gundry SR (2003) Prospective randomized study of a protein-based tissue adhesive used as a hemostatic and structural adjunct in cardiac and vascular anastomotic repair procedures. J Am Coll Surg 197:243–252CrossRefPubMedGoogle Scholar
  11. 11.
    Coselli JS, Conklin LD, LeMaire SA (2003) An effective strategy for optimizing hemostasis following aortic root replacement. J Vasc Br 2:183–186Google Scholar
  12. 12.
    Devbhandari MP, Chaudhery Q, Duncan AJ (2006) Acute intraoperative malfunction of aortic valve due to surgical glue. Ann Thorac Surg 81:1499–1500CrossRefPubMedGoogle Scholar
  13. 13.
    Downing SW (2003) What are the risks of using biologic glues? Ann Thorac Surg 75:1063CrossRefPubMedGoogle Scholar
  14. 14.
    Dunst KM, Antretter H, Bonatti J (2005) Control of suture hole bleeding after aortic valve replacement by application of BioGlue during circulatory arrest. Int Heart J 46:175–179CrossRefPubMedGoogle Scholar
  15. 15.
    Erasmi AW, Sievers HH, Wolschlager C (2002) Inflammatory response after BioGlue application. Ann Thorac Surg 73:1025–1026CrossRefPubMedGoogle Scholar
  16. 16.
    Fehrenbacher JW, Siderys H (2006) Use of BioGlue in aortic surgery: proper application techniques and results in 92 patients. Heart Surg Forum 9:E794–799CrossRefPubMedGoogle Scholar
  17. 17.
    Guerrero MA, Cox M, Lumsden AB, Reardon M, Howell J (2004) Embolus of surgical adhesive to the extremities causing acute ischemia: report of two cases. J Vasc Surg 40:571–573CrossRefPubMedGoogle Scholar
  18. 18.
    Hammond G (1994) Use of glutaraldehyde solution in the treatment of acute aortic dissections (invited commentary). Ann Thorac Surg 58:836CrossRefGoogle Scholar
  19. 19.
    Hoschtitzky JA, Crawford L, Brack M, Au J (2004) Acute coronary syndrome following repair of aortic dissection. Eur J Cardiothorac Surg 26:860–862CrossRefPubMedGoogle Scholar
  20. 20.
    Karimi M, Kerber RE, Everett JE (2005) Mechanical aortic valve malfunction: an intraoperative BioGlue complication. J Thorac Cardiovasc Surg 129:1442–1443CrossRefPubMedGoogle Scholar
  21. 21.
    Kazui T, Washiyama N, Bashar AH, Terada H, Suzuki K, Yamashita K, Takinami M (2001) Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root. Ann Thorac Surg 72:509–514CrossRefPubMedGoogle Scholar
  22. 22.
    LeMaire SA, Schmittling ZC, Coselli JS, Undar A, Deady BA, Clubb FJ Jr, Fraser CD Jr (2002) BioGlue surgical adhesive impairs aortic growth and causes anastomotic strictures. Ann Thorac Surg 73:1500–1505CrossRefPubMedGoogle Scholar
  23. 23.
    LeMaire SA, Carter SA, Won T, Wang X, Conklin LD, Coselli JS (2005) The threat of adhesive embolization: BioGlue leaks through needle holes in aortic tissue and prosthetic grafts. Ann Thorac Surg 80:106–110CrossRefPubMedGoogle Scholar
  24. 24.
    LeMaire SA, Ochoa LN, Conklin LD, Schmittling ZC, Undar A, Clubb FJ Jr, Li Wang X, Coselli JS, Fraser CD Jr (2007) Nerve and conduction tissue injury caused by contact with BioGlue. J Surg Res 143:286–293CrossRefPubMedGoogle Scholar
  25. 25.
    LeMaire SA, Green SY, Sharma K, Cheung CK, Sameri A, Tsai PI, Adams G, Coselli JS (2009) Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients. Ann Thorac Surg 87:503–512 discussion 512–513CrossRefPubMedGoogle Scholar
  26. 26.
    Luthra S, Theodore S, Tatoulis J (2008) Bioglue: a word of caution. Ann Thorac Surg 86:1055–1056, author reply 1056–1057CrossRefPubMedGoogle Scholar
  27. 27.
    Mahmood Z, Cook DS, Luckraz H, O’Keefe P (2004) Fatal right ventricular infarction caused by Bioglue coronary embolism. J Thorac Cardiovasc Surg 128:770–771CrossRefPubMedGoogle Scholar
  28. 28.
    Mastroroberto P, Chello M, Onorati F, Renzulli A (2005) Embolisation, inflammatory reaction and persistent patent false lumen: is biological glue really effective in repair of type A aortic dissection? Eur J Cardiothorac Surg 27:531–532CrossRefPubMedGoogle Scholar
  29. 29.
    Ngaage Dl, Edwards WD, Bell MR, Sundt TM (2005) A cautionary note regarding long-term sequelae of biologic glue. J Thorac Cardiovasc Surg 129:937–938CrossRefPubMedGoogle Scholar
  30. 30.
    Passage J, Jalali H, Tam RK, Harrocks S, O’Brien MF (2002) BioGlue Surgical Adhesive — an appraisal of its indications in cardiac surgery. Ann Thorac Surg 74:432–437CrossRefPubMedGoogle Scholar
  31. 31.
    Raanani E, Georghiou GP, Kogan A, Wandwi B, Shapira Y, Vidne BA (2004) ‘BioGlue’ for the repair of aortic insufficiency in acute aortic dissection. J Heart Valve Dis 13:734–737PubMedGoogle Scholar
  32. 32.
    Shiono M, Hata M, Sezai A, Negishi N, Sezai Y (2005) Surgical results in acute type A aortic dissection. Ann Thorac Cardiovasc Surg 11:29–34PubMedGoogle Scholar
  33. 33.
    Vasseur B, Hammond GL (1989) New technique for repair of ascending thoracic aortic dissections. Ann Thorac Surg 47:318–319PubMedCrossRefGoogle Scholar
  34. 34.
    Volguina IV, Miller DC, Lemaire SA, Palmero LC, Wang XL, Connolly HM, Sundt TM III, Bavaria JE, Dietz HC, Milewicz DM, Coselli JS (2009) Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: analysis of early outcome. J Thorac Cardiovasc Surg 137:641–649CrossRefPubMedGoogle Scholar
  35. 35.
    Yoshitatsu M, Nomura F, Katayama A, Tamura K, Katayama K, Ihara K, Nakashima Y (2004) Pathologic findings of aortic redissection after glue repair of proximal aorta. J Thorac Cardiovasc Surg 127:593–595CrossRefPubMedGoogle Scholar
  36. 36.
    Zehr KJ (2007) Use of bovine albumin-glutaraldehyde glue in cardiovascular surgery. Ann Thorac Surg 84:1048–1052CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Scott A. LeMaire
    • 1
    • 2
  • J. S. Coselli
    • 1
    • 2
  1. 1.The Texas Heart Institute at St. Luke’s Episcopal HospitalHoustonUSA
  2. 2.Division of Cardiothoracic Surgery Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonUSA

Personalised recommendations