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Complications of Bioglue postsurgery for aortic dissections and aortic valve replacement
  1. Adriana Luk1,
  2. Tirone E David2,
  3. Jagdish Butany3
  1. 1Department of Cardiology, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
  3. 3Division of Pathology, Department of Laboratory Medicine and Pathobiology, Toronto General Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Professor Jagdish Butany, Division of Pathology, Department of Laboratory Medicine and Pathobiology, University of Toronto, University Health Network/Laboratory Medicine Program, Toronto General Hospital, 200 Elizabeth Street, E11-444, Toronto, Ontario M5G 2C4, Canada; jagdish.butany{at}uhn.on.ca

Abstract

Aims Bioglue is an adhesive used during cardiovascular surgery to improve hemostasis perioperatively and to strengthen and reinforce vascular anastomoses. It has also been used to ‘seal’ the false lumen in patients presenting with acute aortic dissections. Herein, we examine the complications of Bioglue, which may lead to redo sternotomy in selected patients.

Methods A review of pathology records at our institution from 2002 to 2010 found 4 cases of excised aortic tissue and/or aortic valves with previous Bioglue® use at initial operation. Excised tissues and valves were examined, looking for the presence of Bioglue®, inflammatory cells (acute, chronic, macrophage and giant cells) and micro-organisms. Patient demographics were also reviewed and recorded.

Results We identified four cases of Bioglue use found at redo surgery, after the formation of pseudoaneurysm (n=3) and aortic stenosis (n=1). Mean interval to redo surgery was 2.28 + 0.32 years (range 2-2.6 years). Pseudoaneurysm formation was thought to be caused by an inflammatory reaction to the Bioglue® itself in two cases, while one case found no such reaction. One patient with previous aortic valve replacement had large annular abscesses filled with necrotic debris surrounding the prosthesis and pannus found on the sewing cuff, comprised of Bioglue® itself.

Conclusions The mechanisms leading to these complications include mechanical strain, inflammation and tissue necrosis. The judicious use of Bioglue® when clinically indicated, and close follow-up of these patients with serial imaging, remain an integral part of avoiding future complications.

  • Surgery
  • Cardiothoracic Pathology
  • Vascular Disease
  • Cardiovascular

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