ABSTRACT
A 83-year-old woman suffered pulseless-electrical-activity (PEA) because of cardiac tamponade after acute myocardial infarction with blow-out type cardiac rupture. Immediately median sternotomy was performed and active bleeding from the postero-lateral wall was found. It was impossible to stop bleeding only by putting pressure on the aperture of the myocardium with a piece of TachoComb coated with gelatin-resorcinol-formaldehyde (GRF) glue, however, the chemical action of GRF glue made the delicate myocardium after acute infarction stronger and we managed to stop that bleeding with mattress sutures that had initially seemed to be impossible. She was discharged on POD 103 uneventfully. We think this is a useful and safe operation procedure for blow-out type cardiac rupture.
ABSTRACT
Gelatin-resorcin-formalin (GRF) glue has been widely used in repair of dissected aortic wall tissue, and the use of GRF glue has been reported to significantly reduce mortality from this surgical emergency. On the other hand, various late complications possibly due to GRF glue have also been reported. We performed reoperations after total arch replacement for acute type A aortic dissection using GRF glue in 2 cases. In case 1, total arch replacement was performed 3 years ago. Pseudoaneurysms of the aortic root and brachiocephalic artery and redissection of the descending aorta were revealed by subsequent computed tomography (CT). Partial graft replacement for these 3 sites were performed with open distal anastomosis and right common carotid artery perfusion. In case 2, total arch replacement was performed 5 years previously. Redissection of the aortic root was revealed by CT, and ultrasound cardiography revealed severe aortic regurgitation and severe mitral valve insufficiency. A modified Bentall procedure and mitral valve replacement were performed. In these 2 cases, the sites of redissection and pseudoaneurysm were identified as the sites of use of GRF glue at the first operation. We suspected that the use of GRF glue is associated with a certain amount of risk of redissection and pseudoaneurysm. Such patients should be carefully followed for years after surgery. It is necessary to use appropriate surgical and glue application techniques to obtain the desired effect of the glue.
ABSTRACT
Gelatin-resorcin-formalin (GRF) glue has been generally applied in the surgical treatment of acute aortic dissection. Recently, midterm or late redissection and false anastomotic aneurysm following the use of this adhesive have been reported in several articles and the toxicity of its component has been suggested to be involved in this complication. We herein report 2 cases of aortic root redissection a few years after the initial surgery for type A acute aortic dissection. In another hospital, a 57-year-old man had undergone total arch replacement for acute dissection in which the proximal end was repaired using GRF glue. The aortic root was revealed to be redissected by computed tomography (CT) 2 years after the intervention and continued to enlarge since then. This aortic complication was treated by composite graft replacement. The intraoperative findings of marked degeneration in dissected root tissue were impressive. The other patient was a 71-year-old man. He had undergone prosthetic replacement of the ascending aorta associated with aortic valve resuspension using GRF glue for acute dissection. Three years later, symptoms of cardiac failure due to aortic regurgitation (AR) occurred and necessitated surgical correction. The AR was due to the redissection of the non-coronary cusp sinus. Repair of the coronary sinus and aortic valve replacement was performed. The postoperative course was uneventful in both cases. Other papers have cautioned that this tissue adhesive should not be used in aortic valve resuspension. Intensive long-term follow-up is required for aortic dissection patients surgically treated using this glue.