The proper use of glue: a 20-year experience with the GRF glue in acute aortic dissection.
BACKGROUND
In 1977, the use of Gelatine-Resorcine-Formaline (GRF) biological glue during surgery of acute Type A aortic dissection was proposed. The present study retrospectively analyzes the late results obtained with this adjunct in an experience extending over a twenty-year period of time.


METHODS
From January 1977 to March 1996, 171 patients (124 males and 47 females) aged from 15-79 years (mean age: 53 +/- 14 years) underwent an emergency operation for type A aortic dissection in our institution. All patients suffered from acute type A dissection and 144 (84%) were operated on within 48 hours after the onset of symptoms. Twenty-six patients (15.2%) had Marfan's syndrome. The ascending aorta was replaced in all patients and the aortic stumps were reinforced with the GRF glue. In 39 patients (23%), the aortic valve was replaced either independently (5 cases, 3%) or by means of a composite graft (34 cases, 19.8%). Because of the location of the intimal tear, the aortic replacement was extended to the transverse arch in 58 patients (33.9%).


RESULTS
Hospital mortality amounts to 21% (36 patients), 22.8% in patients with arch replacement and 21.1% in patients without arch replacement (n.s). One hundred thirty-five patients were discharged and surveyed from 2 months to 19 years postoperatively (cumulative follow-up: 856 patients/years. Mean follow-up: 79 +/- 66 months). During this period of time, 22 patients (16.1%) had to be reoperated on for a total of 28 reoperations. Six of those (27.2%) died at reoperation. At univariate analysis, presence of Marfan's syndrome (p < 0.05) and absence of arch replacement (p < 0.02) were determinant risk factors for reoperation. Emergency (p < 0.01) and thoracoabdominal replacement (p < 0.04) were determinant risk factors of death at reoperation. The acturial freedom from reoperation (Kaplan-Meier, CI: 95%) is: 96.08% (90.9-98.2), 87.6% (79.8-92.7), 80.9% (70.8-86.1), 66.4% (51.1-78.9) at 1, 5, 10, and 15 years respectively. A total of 36 patients (27.7%) died during follow-up. Presence of Marfan's syndrome (p < 0.01), reoperation (p < 0.02), stroke (p < 0.05), cardiac failure (p < 0.05) were determinant risk factors of late mortality. The actuarial late survival rate (K-M. C.I.: 95%), including hospital mortality, is: 71.5% (64.3-77.8), 66% (58.3-73), 56.4% (47.7-64.7), 46.3% (36.4-56.5) at 1, 10 and 15 years.


CONCLUSIONS
The GRF glue has proved to be extremely useful during emergency initial surgery for acute type A dissection, making the procedure much easier and safer. Through this operative improvement, the use of the GRF glue seems to have a beneficial influence on the late results which however, depend mainly on the patient's basic condition.
Bachet
J
J
Service de Chirurgie Cardio-Vasculaire, Hôpital Foch, Université René, Suresnes, France.
Goudot
B
B
Dreyfus
G
G
Banfi
C
C
Ayle
N A
NA
Aota
M
M
Brodaty
D
D
Dubois
C
C
Delentdecker
P
P
Guilmet
D
D
D000206:Actuarial Analysis; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001807:Blood Vessel Prosthesis; D004338:Drug Combinations; D005260:Female; D005557:Formaldehyde; D005780:Gelatin; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000601:surgery; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012118:Resorcinols; D016019:Survival Analysis; D014014:Tissue Adhesives
D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin