Does BioGlue Contribute to Anastomotic Pseudoaneurysm After Thoracic Aortic Surgery?

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2017 Sep 22

PMID 28932555

Citations 4

Authors

Wei-Guo Ma

Bulat A Ziganshin

Chang-Fa Guo

Mohammad A Zafar

Richard S Sieller

Maryann Tranquilli

John A Elefteriades

Affiliations

Soon will be listed here.

Abstract

Background: Although bovine serum albumin-glutaraldehyde glue (BioGlue®) has been successfully used as a hemostatic adjunct in aortic surgical procedures, there are reports that it may lead to anastomotic pseudoaneurysm formation. We seek to examine if the use of BioGlue is associated with a high incidence of anastomotic pseudoaneurysm formation following surgical repair of thoracic aortic disease.

Methods: We reviewed the medical records and follow-up computed tomography (CT) scans of patients from 2001 to 2015 in whom BioGlue was used during surgical repair of thoracic aortic disease to detect postoperative anastomotic pseudoaneurysm formation.

Results: A total of 233 patients with BioGlue use were identified. Mean age was 63.5±14.0 years (median 66; range 14-88; 25-75%, IQR 54-74 years) and 149 were male (63.9%). Surgical indication was thoracic aortic aneurysm in 169 (72.5%) patients, aortic dissection in 49 (21.0%), intramural hematoma in 9 (3.9%), penetrating aortic ulcer in 3 (1.3%) and other in 3 (1.3%). Emergency/urgent surgery was performed in 68 cases (29.2%). Operative mortality was 7.3% (17/233). Re-exploration for bleeding and neurologic deficits occurred in 24 (10.3%) and 21 (9.0%) patients respectively. All operative survivors were followed (100%, 216/216) and CT follow-up was available in 81.9% (177/216) for a mean duration of 2.4 years (median 0.6; 25-75% IQR 0.2-3.6 years). Anastomotic pseudoaneurysm was detected in 1 patient (0.6%) at 3 years postoperatively. This was an elderly female with extremely frail tissues who underwent a reoperative ascending and arch replacement for dissection.

Conclusions: The use of BioGlue in thoracic aortic surgery was not associated with excess incidence of anastomotic pseudoaneurysm formation following surgical repair of thoracic aortic disease. Its use need not be discouraged on this basis.

Citing Articles

Abrupt left coronary artery malperfusion secondary to acute type A aortic dissection after weaning from cardiopulmonary bypass: a case report.

Jang M, Nam S, Kim Y, Song S BMC Cardiovasc Disord. 2025; 25(1):161.

PMID: 40055640 PMC: 11887110. DOI: 10.1186/s12872-025-04556-4.

Commentary: The Balloon and Glue Technique in Acute Type A Aortic Dissection: Considerations for Optimization and Clinical Application.

Cho S J Chest Surg. 2025; 58(2):70-72.

PMID: 40015685 PMC: 11884979. DOI: 10.5090/jcs.25.011.

Polytetrafluoroethylene Felt Inlay Neomedia and Tissue Glue Do Not Prevent Reoperation in Type A Aortic Dissection.

Miazza J, Koechlin L, Gahl B, Berdajs D, Vohringer L, Eckstein F J Clin Med. 2024; 13(22).

PMID: 39597807 PMC: 11595186. DOI: 10.3390/jcm13226663.

Early surgical outcomes in the composite-valve root replacement with bioprosthesis after surgery for acute type A aortic dissection.

Seike Y, Sakaguchi K, Shinzato K, Yoshida K, Koda Y, Masada K Gen Thorac Cardiovasc Surg. 2024; .

PMID: 39217578 DOI: 10.1007/s11748-024-02075-1.

BioGlue is not associated with polypropylene suture breakage after aortic surgery.

Pacini D, Murana G, Hollinworth D, Northrup W, Arnold S, Di Bartolomeo R Front Surg. 2022; 9:976944.

PMID: 36176339 PMC: 9514387. DOI: 10.3389/fsurg.2022.976944.

References

Bavaria J, Brinster D, Gorman R, Woo Y, Gleason T, Pochettino A . Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg. 2002; 74(5):S1848-52; discussion S1857-63. DOI: 10.1016/s0003-4975(02)04128-0. View

Westaby S, Saito S, Katsumata T . Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg. 2002; 73(3):707-13. DOI: 10.1016/s0003-4975(01)03449-x. View

Rylski B, Bavaria J, Milewski R, Vallabhajosyula P, Moser W, Kremens E . Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection. Ann Thorac Surg. 2014; 98(2):582-8. DOI: 10.1016/j.athoracsur.2014.04.050. View

Milano A, Pratali S, Mecozzi G, Boraschi P, Braccini G, Magagnini E . Fate of coronary ostial anastomoses after the modified Bentall procedure. Ann Thorac Surg. 2003; 75(6):1797-801; discussion 1802. DOI: 10.1016/s0003-4975(03)00015-8. View

Weiner J, Widman S, Golek Z, Tranquilli M, Elefteriades J . Role of bovine serum albumin-glutaraldehyde glue in the formation of anastomatic pseudoaneurysms. J Card Surg. 2010; 26(1):76-81. DOI: 10.1111/j.1540-8191.2010.01162.x. View

Fehrenbacher J, Siderys H . Use of BioGlue in aortic surgery: proper application techniques and results in 92 patients. Heart Surg Forum. 2006; 9(5):E794-9. DOI: 10.1532/hsf98.20061066. View

Koveker G, de Vivie E, Hellberg K . Clinical experience with fibrin glue in cardiac surgery. Thorac Cardiovasc Surg. 1981; 29(5):287-9. DOI: 10.1055/s-2007-1023497. View

Fink D, Klein J, Kang H, Ergin M . Application of biological glue in repair of intracardiac structural defects. Ann Thorac Surg. 2004; 77(2):506-11. DOI: 10.1016/S0003-4975(03)01533-9. View

LeMaire S, Green S, Sharma K, Cheung C, Sameri A, Tsai P . Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients. Ann Thorac Surg. 2009; 87(2):503-12. DOI: 10.1016/j.athoracsur.2008.11.033. View

10.

Luk A, David T, Butany J . Complications of Bioglue postsurgery for aortic dissections and aortic valve replacement. J Clin Pathol. 2012; 65(11):1008-12. DOI: 10.1136/jclinpath-2012-200809. View

11.

Ozaslan F, Wittlinger T, Monsefi N, Bouhmidi T, Theres S, Doss M . Long-term follow-up of supra-annular pulmonary autograft aortic root replacement in patients with bicuspid aortic valve. Eur J Cardiothorac Surg. 2008; 34(3):583-8. DOI: 10.1016/j.ejcts.2008.05.056. View

12.

Ngaage D, Edwards W, Bell M, Sundt T . A cautionary note regarding long-term sequelae of biologic glue. J Thorac Cardiovasc Surg. 2005; 129(4):937-8. DOI: 10.1016/j.jtcvs.2004.07.046. View

13.

Guilmet D, Bachet J, Goudot B, Laurian C, Gigou F, Bical O . Use of biological glue in acute aortic dissection. Preliminary clinical results with a new surgical technique. J Thorac Cardiovasc Surg. 1979; 77(4):516-21. View

14.

Elefteriades J . "How I do it: utilization of high-pressure sealants in aortic reconstruction". J Cardiothorac Surg. 2009; 4:27. PMC: 2708158. DOI: 10.1186/1749-8090-4-27. View

15.

Coselli J, Bavaria J, Fehrenbacher J, Stowe C, Macheers S, Gundry S . 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. 2003; 197(2):243-52; discussion 252-3. DOI: 10.1016/S1072-7515(03)00376-4. View

16.

Downing S . What are the risks of using biologic glues?. Ann Thorac Surg. 2003; 75(3):1063; author reply 1063-4. DOI: 10.1016/s0003-4975(02)03473-2. View

17.

Nishida H, Tabata M, Fukui T, Takanashi S . Surgical Strategy and Outcome for Aortic Root in Patients Undergoing Repair of Acute Type A Aortic Dissection. Ann Thorac Surg. 2015; 101(4):1464-9. DOI: 10.1016/j.athoracsur.2015.10.007. View

18.

Hewitt C, Marra S, Kann B, Tran H, Puc M, Chrzanowski Jr F . BioGlue surgical adhesive for thoracic aortic repair during coagulopathy: efficacy and histopathology. Ann Thorac Surg. 2001; 71(5):1609-12. DOI: 10.1016/s0003-4975(01)02424-9. View

19.

Stylli S, Kumar A, Gonzales M, Kaye A . The biocompatibility of BioGlue with the cerebral cortex: a pilot study. J Clin Neurosci. 2004; 11(6):631-5. DOI: 10.1016/j.jocn.2004.03.018. View

20.

Alameddine A, Alimov V, Rousou J, Freeman J . Aorto-pulmonary artery disruption following acute type-A aortic dissection repair with the use of BioGlue®. J Card Surg. 2012; 27(3):371-3. DOI: 10.1111/j.1540-8191.2012.01441.x. View