title: Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root.
abstract: BACKGROUND
  Redissection of the aortic root after supracommissural aortic graft replacement with reapproximation of the layers of the dissected aortic root is relatively rare. Causes and surgical treatment of this lesion remain controversial.
  
  
  METHODS
  From January 1983 to September 2000, 130 patients had emergency operation for acute type A aortic dissection. Of them, 57 patients underwent root reconstruction using biologic glues and 4 patients (7.0%) developed redissection of the aortic root associated with moderate to severe aortic regurgitation 5 to 27 months after the initial operation. In all patients, the proximal false lumen was obliterated with infusion of gelatin-resorcinol-formaldehyde (GRF) glue or BioGlue and the aorta was reinforced with Teflon felt strip or Surgicel placed on its outside wall.
  
  
  RESULTS
  During reoperation, the noncoronary aortic sinus was found to be redissected in all patients with the dissection extending retrogradely to the aortic annulus. This resulted in aortic regurgitation with prolapse of the noncoronary cusp because the proximal suture line dehisced. Histopathology showed disappearance of the nuclei of the medial smooth muscle cells, suggesting tissue necrosis at the site of GRF glue application. The lesions were treated successfully with full root replacement using a freestyle heterograft bioprosthesis or a composite graft prosthesis.
  
  
  CONCLUSIONS
  The use of biologic glues for reapproximating the layers of the dissected aortic root is associated with a certain amount of risk of aortic wall necrosis. Therefore, care should be taken to ensure proper use of these glues. Full root replacement could be a preferable technique for treating redissection of the aortic root.
authors.affiliation: First Department of Surgery, Hamamatsu University, School of Medicine, Handayama, Japan. tkazui@hama-med.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Kazui
authors.forename: N
authors.initials: N
authors.lastname: Washiyama
authors.forename: A H
authors.initials: AH
authors.lastname: Bashar
authors.forename: H
authors.initials: H
authors.lastname: Terada
authors.forename: K
authors.initials: K
authors.lastname: Suzuki
authors.forename: K
authors.initials: K
authors.lastname: Yamashita
authors.forename: M
authors.initials: M
authors.lastname: Takinami
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005557:Formaldehyde / Q000008:administration & dosage / Q000009:adverse effects*; D005780:Gelatin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000473:pathology; D009336:Necrosis; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012118:Resorcinols / Q000008:administration & dosage / Q000009:adverse effects*; D014014:Tissue Adhesives
chemical_list: D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin