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Nagasaka K, Watanabe S, Ito S, Ichimaru H, Nishiguchi A, Otsuka H, Taguchi T. Enhanced burst strength of catechol groups-modified Alaska pollock-derived gelatin-based surgical adhesive. Colloids Surf B Biointerfaces 2022; 220:112946. [DOI: 10.1016/j.colsurfb.2022.112946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/27/2022]
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Naganuma M, Akiyama M, Takaya H, Sakuma K, Kumagai K, Kawamoto S, Adachi O, Saiki Y. Maximization of the sealing effect of fibrin glue in aortic surgery. Gen Thorac Cardiovasc Surg 2019; 68:18-23. [PMID: 31177484 DOI: 10.1007/s11748-019-01155-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fibrin glue is used to reinforce anastomosis in aortic surgery. There has not yet been a consensus on how it should be applied optimally. This study aimed to define the optimal condition of applying fibrin glue. METHODS In experiment 1, we determined the optimal condition for spraying fibrin glue using an expanded polytetrafluoroethylene graft within a needle hole. The length and area of the fibrin cap within the hole were measured. In experiment 2, methods for applying fibrinogen were assessed by comparing brushing and spraying. In experiment 3, swine aorta segments sutured with a Dacron graft were divided into the following three groups: nothing was applied; fibrinogen was sprayed and rubbed using brush. The aorta was clamped and blood was infused from an occlusion catheter inserted into the graft. The pressure at the first appearance of blood leak was recorded. RESULTS In experiment 1, among the four groups divided by the pressure and distance of spraying, the fibrin cap area in the group with 0.075 MPa and 2-cm spray distance was significantly larger than that in the group with 0.15 MPa and 2 cm (P < 0.01). In experiment 2, the fibrin cap area in the brushing group was significantly larger than that in the spraying group (P < 0.05). In experiment 3, the capacity to resist endoluminal pressure was higher in the brushing and combined spraying group compared with that in the sequential combined spraying group (P < 0.01). CONCLUSIONS The brush and spray methods showed excellent hemostatic outcomes.
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Affiliation(s)
- Masaaki Naganuma
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Masatoshi Akiyama
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Hiroki Takaya
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kei Sakuma
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kiichiro Kumagai
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Osamu Adachi
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
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Liu H, Zhang SJ, Shao YF, Lu XH, Gu WD, Ni BI, Gu Q, Du JJ. Biomechanical characterization of a novel ring connector for sutureless aortic anastomosis. J Biomed Res 2018; 32:454-460. [PMID: 28963444 PMCID: PMC6283826 DOI: 10.7555/jbr.31.20170011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/20/2017] [Indexed: 12/04/2022] Open
Abstract
The surgical treatment for aortic diseases remains a challenge for any cardiac surgeon. The use of sutureless ring connector in aortic anastomosis can simplify the procedure and shorten anastomosis time. Therefore, we developed a novel device for sutureless aortic anastomosis. A series of experiments were carried out for tensile and leakproof-capacity assessments to verify the feasibility of the ring connector by using fresh swine aorta samples. In in vivo test, the ring connector was implanted in 6 swine with follow-up of 6 months. Radiographic and pathological studies of the aorta were performed. In the tensile tests, the strength was 32.7±5.9 Newton (N) in the sutureless anastomosis group, compared with 73.3±12.5 N in the control group by traditional manual suture. In the leakproof-capacity assessment, no sign of either leakage or bursting was evident at 280 mmHg of internal pressure in the aorta samples. In in vivo tests, it took 9.47±0.3 minutes for the sutureless anastomosis, compared with 15.58±1.39 minutes for hand-sewn suturing. Insertion was easy and rapid. Radiographic and pathological studies were performed at first month, third month and sixth month after surgery, each time obtained from the two swine, showed patency of the anastomosis and no signs of stenosis, blood leakage, migration or pseudoaneurysm formation, except one paralyzed swine developed of thrombo-occlusion at the site of the sutureless anastomosis. The result indicates that this novel ring connector offers considerable promise for sutureless aortic anastomosis.
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Affiliation(s)
- Huan Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Shi-jiang Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yong-feng Shao
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiao-hu Lu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Wei-dong Gu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Buq-ing Ni
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Qun Gu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jun-jie Du
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
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The use of surgical glue in acute type A aortic dissection. Gen Thorac Cardiovasc Surg 2013; 62:207-13. [DOI: 10.1007/s11748-013-0343-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Fibrin sealants are used for hemostasis and tissue adherence. AIM OF STUDY This systematic review summarizes published clinical data for fibrin sealant use in cardiovascular surgery. METHODS A literature search for the following terms was conducted using PubMed and EMBASE: (TISSEEL or Tissucol or Beriplast P or Evicel or Quixil or Crosseal or Reliseal or Fibringluraas or Bolheal or Tachosil or Vivostat or Vitagel or Artiss or "fibrin glue" or "fibrin sealant" or "fibrin tissue adhesive") and (cardiac or cardiovascular or vascular or heart or coronary or surgery). Case reports and series were excluded; although reports of controlled trials were preferred, uncontrolled trial data were also considered. RESULTS Clinical trials and chart review analyses of fibrin sealants were identified and summarized. Although clinical trial data were available for other agents, the majority of published studies examined TISSEEL. Overall, TISSEEL and other fibrin sealants showed improvements over standard of care or control groups for a variety of predefined endpoints. Safety findings are also summarized. CONCLUSIONS Data from these studies showed that fibrin sealants were well tolerated and provided effective hemostasis in a range of cardiac and aortic surgeries.
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Affiliation(s)
- John A Rousou
- Division of Cardiac Surgery, Baystate Medical Center, Springfield, Massachusetts 01107, USA.
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El-Bishry A, Al-Khaja N, Krebber H, El Fiki M, Aziz MA, Enein HA, Saeed M, Sallam I. Acute Type A Aortic Dissection. Influence of Early Management on Results. Asian Cardiovasc Thorac Ann 2001. [DOI: 10.1177/021849230100900205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One hundred and six patients were operated upon for acute type A aortic dissection in 7 years between February 1992 and May 1999. There were 102 males and 4 females, aged 18 to 83 years with a mean of 59 ± 14 years. All patients underwent surgery within 14 hours of diagnosis. The ascending aorta was replaced with a Dacron graft in 103 patients; in the other 3 cases, the repair extended to the aortic arch. The aortic valve was preserved by resuspension in all except 4 patients, 3 of whom had Marfan's syndrome. There were 9 (8.5%) deaths, all due to respiratory and multiorgan failure. Nine patients (8.5%) needed hemodialysis; only one of these required permanent dialysis. Ten patients (9.4%) had transient neurological disorders, 2 others (1.9%) suffered permanent hemiplegia. Three patients (2.8%) underwent reoperation for bleeding. Tracheostomy for prolonged respiratory assistance was required in 6 patients (5.7%), of whom 1 died from respiratory failure. Early surgical intervention could be performed with low morbidity and mortality.
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Affiliation(s)
| | | | | | - Mohamed El Fiki
- Department of Cardiovascular Surgery Naser Institute Cairo, Egypt
| | | | | | | | - Ismail Sallam
- Department of Cardiovascular Surgery Naser Institute Cairo, Egypt
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Tanaka K, Takamoto S, Ohtsuka T, Kotsuka Y, Kawauchi M. Application of AdvaSeal for acute aortic dissection: experimental study. Ann Thorac Surg 1999; 68:1308-12; discussion 1312-3. [PMID: 10543498 DOI: 10.1016/s0003-4975(99)00757-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the surgical treatment of acute aortic dissection, intractable hemorrhage often occurs. We performed an animal study to test the hypothesis that a new sealant, AdvaSeal (Ethicon Inc, Johnson & Johnson Medical KK, Somerville, NJ), can close the false channel of aortic dissection. METHODS Acute descending aortic dissection was created surgically in 12 mongrel dogs. In 7 of these (treated group), AdvaSeal was applied to the false cavity for reinforcing and fusing the dissected layers and also to the suture line. The other 5 dogs (control) were left untreated. Specimens were harvested 2 weeks after surgery. RESULTS The sealant could be used in wet conditions. In the treated group, hemostasis was easily achieved during surgery. All false cavities were perfectly thrombosed, causing no deleterious effects related to the sealant. In the control group, all false lumina remained patent. CONCLUSIONS The advantage of AdvaSeal was its effectiveness on wet tissue and its adhesiveness, allowing good hemostasis and closure of the false lumen. The sealant can be an easy and efficacious sealant in treatment for acute aortic dissection.
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Affiliation(s)
- K Tanaka
- Department of Cardiothoracic Surgery, Faculty of Medicine, University of Tokyo, Japan.
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Nguyen B, Müller M, Kipfer B, Berdat P, Walpoth B, Althaus U, Carrel T. Different techniques of distal aortic repair in acute type A dissection: impact on late aortic morphology and reoperation. Eur J Cardiothorac Surg 1999; 15:496-500; discussion 500-1. [PMID: 10371128 DOI: 10.1016/s1010-7940(99)00036-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare three different techniques of distal aortic repair in acute type A (de Bakey type I) aortic dissection and to evaluate their impact on the late morphology of the aortic arch and descending aorta and on the incidence of reoperation. METHODS From 65 patients operated on due to an acute type A aortic dissection between 1989 and 1993, 54 long-term survivors underwent clinical and radiologic follow-up examination after a mean postoperative interval of 62+/-16 months. The surgical techniques of distal aortic reconstruction included closed repair using Teflon felt reinforcement under moderate hypothermic cardiopulmonary bypass (n = 20) and open repair in deep hypothermic circulatory arrest using either Teflon felt reinforcement (n = 16) or gelatin-resorcin-formaldehyde (GRF) glue (n = 18) to readapt the dissected aortic layers. In all patients, MR imaging was performed on a 1.5-T whole body imaging system for the evaluation of the morphology and function of the heart, aorta and supraaortic branches. RESULTS Overall hospital mortality following surgical repair of type A aortic dissection was 15.4% during this time period. The highest rate of persistent false lumen perfusion (17/20, 85%) and presence of an intimal flap in the aortic arch (13/20, 65%) was observed in patients following closed repair of acute ascending aortic dissection, whereas the lowest rate of such findings was demonstrated in patients who had undergone open distal aortic repair using biological glue (false lumen perfusion 10/18, 55% and intimal flap in the arch 2/18, 11%). Redo-surgery was significantly reduced in the open repair group using GRF glue (1/18, 5.5%) as compared with the Teflon felt repair group (3/16, 18%) and the closed repair group (6/20, 30%). CONCLUSIONS In patients with acute type A dissection, open distal aortic repair using GRF-glue favourably influences both (1) the severity of late morphologic alterations in the downstream aorta and (2) the incidence of reoperation.
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Affiliation(s)
- B Nguyen
- Clinic for Thoracic and Cardiovascular Surgery, University Hospital, Berne, Switzerland
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Walker JD, Kratz JM, Basler CG, Meck LP, Stratton JR, Kribbs SB, Crawford FA, Spinale FG. Fate of gelatin-resorcinol-formaldehyde/glutaraldeyde adhesive on femoral vessel morphology. J Surg Res 1997; 71:73-8. [PMID: 9271281 DOI: 10.1006/jsre.1997.5128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Several clinical reports have demonstrated that gelatin-resorcinol-formaldehyde/glutaraldehyde (GRFG) glue can be useful in the repair of acute aortic dissection; however, the cellular and extracellular events that follow GRFG application, as well as the mechanisms responsible for the long-term strength and adhesive properties of GRFG, remain unclear. Accordingly, the present study examined the long-term effects of GRFG adhesive application on femoral vessel extracellular structure and composition. The left and right femoral artery and vein were sterilely exposed in adult rats, and GRFG (2 mL) was applied between and around one pair of vessels. An equivalent amount of sterile saline was applied to the contralateral vessels to serve as an intrinsic control. At either 1 (n = 6) or 2 (n = 6) months postoperatively, the lower extremities were perfusion fixed and harvested to preserve the native anatomy and cytoarchitecture of the femoral region. Gross examination of the specimens revealed no evidence of necrosis or wound breakdown. Tissue blocks (4 microm) were then sectioned perpendicular to the treated vessel region and subjected to histomorphometric analysis using computer-assisted microscopy. The perivascular capsule area, relative content of fibrillar collagen, and number of nucleated cells within the interstitial space were computed. At 1 and 2 months following the application of GRFG adhesive, perivascular capsular size increased by 42 and 221%, respectively. Perivascular interstitial collagen content increased by 21% at 1 month and by 50% at 2 months. The nucleated cell number increased by 107% at 1 month and by 166% at 2 months. This cellular infiltrate appeared to be of fibroblastic morphology. Thus, a potential contributory mechanism to the long-term strength and adhesive capacities of GRFG adhesive may be extracellular remodeling and not the intrinsic properties of GRFG glue itself.
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Affiliation(s)
- J D Walker
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, 21425, USA
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Abstract
Fibrin glue (FG) is used to control bleeding, to adhere tissues together, and to seal tissue defects. FG is prepared from platelet-rich plasma or by mixing concentrated fibrinogen solutions with thrombin. Concentrated fibrinogen solutions are produced by cryoprecipitation or by chemical precipitation of plasma. The literature on FG preparation is reviewed in order to compare the advantages and disadvantages of the different products reported and to summarize the clinical applications. It is concluded that additional studies are needed to fully evaluate the advantages and disadvantages of fibrinogen concentrated using cryoprecipitation and chemical precipitation and that specific advantages exist for use of both pooled homologous and autologous blood.
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Affiliation(s)
- F H Silver
- Department of Pathology, UMDNJ-Robert Wood Johnson Medical School, Piscataway 08854, USA
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Milne AA, Murphy WG, Reading SJ, Ruckley CV. Fibrin sealant reduces suture line bleeding during carotid endarterectomy: a randomised trial. Eur J Vasc Endovasc Surg 1995; 10:91-4. [PMID: 7633976 DOI: 10.1016/s1078-5884(05)80203-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To determine whether topical fibrin sealant reduced suture line bleeding during carotid endarterectomy with polytetrafluoroethylene (PTFE) patch closure. DESIGN Prospective randomised non-blinded control trial. SETTING Regional vascular surgery unit. MATERIALS Seventeen patients undergoing carotid endarterectomy were randomised either to receive fibrin sealant as a topical haemostatic agent at the arteriotomy suture line or to act as control. OUTCOME MEASURES Time taken to achieve haemostasis at the suture line. Intraoperative blood loss. Total operative time. RESULTS The median time to achieve haemostasis was 5.5 min (range 4-31 min) in the treatment group and 19 min (range 10-47 min) in the control group. This difference was statistically significant p < 0.005 by Mann-Whitney test. There was no statistical difference in total operative time. Operative blood loss was lower in the treatment group (median 420ml, range 300-500ml) than in the control group (median 550ml, range 350-1200ml) but this difference was not statistically significant. One patient in the control group suffered a perioperative thrombo-embolic event. CONCLUSION Fibrin sealant is an effective topical haemostatic agent for arteriotomy suture lines involving PTFE material.
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Affiliation(s)
- A A Milne
- Department of Surgery, University of Edinburgh, Scotland
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Séguin JR, Picard E, Frapier JM, Chaptal PA. Repair of the aortic arch with fibrin glue in type A aortic dissection. J Card Surg 1994; 9:734-8; discussion 738-9. [PMID: 7841653 DOI: 10.1111/j.1540-8191.1994.tb00908.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Location of the intimal tear in the aortic arch in type A aortic dissection is for many authors an indication for replacement of the aortic arch, but this operation has a high in-hospital mortality rate: 20% to 40%. Instead, we suggest repairing the aortic arch by injecting fibrin glue, which contains a human sealer protein concentrate, between the two dissected layers under circulatory arrest while replacing the ascending aorta. To evaluate this technique, we reviewed 45 successive patients operated on for type A acute aortic dissection between January 1989 and July 1993, of which 6 had the intimal tear located on or extending into the aortic arch. Mean age was 71 +/- 4.2 years (range 68 to 74). After proximal supracoronary anastomosis with a collagen-impregnated graft, aortic arch repair was achieved by injecting fibrin glue between the two layers, using circulatory arrest at a mean temperature of 22 degrees C, with a mean duration of 24 minutes. This obliterated the dissection in the arch and also the intimal flap. The distal part of the graft was then anastomosed to the proximal portion of the aortic arch at the origin of the innominate artery under circulatory arrest. There were no early or late deaths. All patients were asymptomatic at a mean follow-up of 2.6 years. Follow-up angioscan showed obliteration of the dissection in the aortic arch in all patients; there were two patients with dilatation of the distal aortic arch of 40 and 45 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J R Séguin
- Thoracic and Cardiovascular Surgery Unit, C.H.U. Hôpital A de Villeneuve, Montpellier, France
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Séguin JR, Picard E, Frapier JM, Chaptal PA. Aortic valve repair with fibrin glue for type A acute aortic dissection. Ann Thorac Surg 1994; 58:304-6; discussion 306-7. [PMID: 8067824 DOI: 10.1016/0003-4975(94)92197-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Repair of the acute aortic insufficiency associated with type A aortic dissection is now preferred to valve replacement. This is generally achieved by resuspending the aortic valve using different types of suturing techniques, with sutures usually passing through the aortic wall, which causes bleeding at the suture sites. We suggest, instead, simply injecting fibrin glue between the two dissected layers of the aortic annulus, which achieves resuspension of the aortic valve and reinforces the proximal stump without the need for any sutures. To evaluate the efficacy of this simple technique, the cases of 15 consecutive patients who underwent operative intervention for the treatment of the type A aortic dissection associated with acute aortic insufficiency between January 1989 and July 1993 were reviewed. The mean patient age was 63 +/- 11.2 years (range, 43 to 74 years). All had massive 3+ or 4+ aortic insufficiency, documented pre-operatively by transesophageal echocardiography. None had any history of aortic regurgitation. In all patients, the aortic repair was done in conjunction with a supracoronary replacement of the ascending aorta with a collagen-impregnated graft attached using a running suture, after reinforcement of the dissected tissues with glue. There was one non-valve-related early death (6.7%) and no late mortality. At a mean follow-up of 2.3 years, all patients were in New York Heart Association functional class I and had a mean aortic insufficiency grade of 0.3 (range, 0 to 1+). Follow-up computed tomography in all patients showed closure of the dissecting process on the proximal ascending aorta.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J R Séguin
- Thoracic and Cardiovascular Surgery Unit, CHU Hôpital A. de Villeneuve, Montpellier, France
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Westaby S, Parry A, Giannopoulos N, Pillai R. Replacement of the thoracic aorta with collagen-impregnated woven Dacron grafts. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)34075-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Padró JM, Mesa JM, Silvestre J, Larrea JL, Caralps JM, Cerrón F, Aris A. Subacute cardiac rupture: repair with a sutureless technique. Ann Thorac Surg 1993; 55:20-3; discussion 23-4. [PMID: 8417684 DOI: 10.1016/0003-4975(93)90468-w] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Thirteen patients with ages between 53 and 74 years had development of free wall left ventricular rupture after a myocardial infarction (mean interval, 3.8 days). All patients showed clinical signs of cardiac tamponade. Diagnosis was established by bedside multiple pressure monitoring and echocardiography, which showed pericardial effusion with compression of the right ventricle. Cardiac catheterization was not performed. A new surgical technique was employed for the repair. After the pericardium was opened and cardiac tamponade was relieved, the myocardial tear was identified. A Teflon patch was applied over the area and glued to the heart surface with a surgical glue (cyanoacrylate). Cardiopulmonary bypass was not used except in a patient with a posterior tear. The method was consistently effective in controlling bleeding from the myocardial tear. All patients survived the operation and were discharged from the hospital a mean of 15 days after the operation. Follow-up extending up to 5 years (mean, 26 months) shows a 100% survival, 11 asymptomatic patients, and 2 patients with mild exertional angina. The technique is a simple, effective, and safe method for repair of subacute cardiac rupture and obviates the need for suturing on an infarcted ventricle.
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Affiliation(s)
- J M Padró
- Cardiac Surgery Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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