Foreign Material Reaction to BioGlue (R) as a Possible Cause of Cardiac Tamponade
ABSTRACT We describe the case of a 65-year-old female patient who underwent aortic valve reconstruction for aortic valve stenosis. During the operation, repair of a left ventricular laceration produced by a left ventricular vent was necessary. BioGlue® (CryoLife, Atlanta, GA, USA) and pledgeted sutures were used for repair. Pericardial effusion with signs of cardiac tamponade developed five months later. The patient was treated successfully by the removal of all foreign material and part of the BioGlue®. Microbiological findings were sterile. Histology showed a chronic granulomatous inflammatory response suggesting a foreign material reaction to BioGlue® as the cause of the effusion. Though all visible material was removed, the risk of pericardial effusion still persists as part of the BioGlue® remained within the ventricular wall.
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ABSTRACT: We describe the development of a highly elastic and adhesive surgical tissue sealant, based on photochemically crosslinked gelatin, for sealing sutured incisions in the gastrointestinal (GI) tract in a rabbit surgical model and in a canine colon anastomosis study. The study included in vitro assessment of mechanical parameters of the tissue sealant and in vivo analysis of burst strength and histology at 24 h, 3 days and 7 days post surgery, in a rabbit model, to assess progress of wound healing at the suture sites. Utility of this sealant to repair and seal a lower colonic resection and anastomosis procedure in a canine model was also investigated. We show that a photopolymerised gelatin tissue sealant provides effective sealing of GI incisions and facilitates wound healing with no evidence of inflammation up to 28 days post-surgery. Blending of derivatised gelatin with underivatised gelatin allowed tuning of elasticity and elastic modulus of the photopolymerised sealant to suit surgical applications. High tissue adhesive strength was maintained at all blend ratios and exceeded 100 kPa. This highly elastic and adhesive photopolymerised gelatin tissue sealant offers a number of advantages over currently available sealants suitable for GI surgical procedures.Journal of Gastrointestinal Surgery 11/2011; 16(4):744-52. DOI:10.1007/s11605-011-1771-8 · 2.39 Impact Factor
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ABSTRACT: 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. 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. 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. 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.Journal of clinical pathology 08/2012; 65(11):1008-12. DOI:10.1136/jclinpath-2012-200809 · 2.55 Impact Factor
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ABSTRACT: Acute type A aortic dissection (AAAD) remains a lethal disease. With advances in operative methods and perioperative management, surgical outcomes continue to improve, but in-hospital mortality still ranges from 10 to 30 % in most series. The surgical technique of choice for aortic root repair remains controversial. Surgical glue created a breakthrough in surgery for acute aortic dissection. We review the surgical techniques with the use of surgical glue for AAAD.General Thoracic and Cardiovascular Surgery 11/2013; 62(4). DOI:10.1007/s11748-013-0343-0