Dissected aortic sinuses repaired with gelatin-resorcin-formaldehyde (GRF) glue are not stable on follow up.
OBJECTIVE
The chemical glue, gelatin, resorcin and formaldehyde (GRF) is widely used to obliterate the false lumen of acute dissected aortic wall tissue.


METHODS
A retrospective review of 41 consecutive patients operated upon for ascending aortic dissection between 1993 and 2000 was conducted. This study focused on 19 patients with acute aortic dissection in whom the aortic valve was resuspended and GRF glue used in the proximal aortic sinuses. These patients were compared with ascending aortic dissection patients in whom the aortic valve was not resuspended. In total, nine acute and 13 chronic dissections were performed in which aortic valve replacement, valve-sparing root reconstruction (without GRF glue), or no aortic valve surgery was carried out.


RESULTS
The operative mortality for ascending aortic dissections was 24.4%; identified risk factors included the specific surgeon involved. Third-degree heart block occurred only in patients in whom GRF glue was used in the proximal aortic sinus (15% incidence). Operative survivors in whom the aortic valve was resuspended and GRF glue used in the proximal aortic sinus, had a 64% incidence of late recurrent aortic regurgitation requiring reoperation due to recurrent aortic sinus aneurysm formation with or without recurrent proximal aortic dissection. No recurrence of aortic regurgitation or proximal disease occurred in the other two groups (p <0.01). Actuarial survival of patients in whom the aortic valve was resuspended with GRF glue was 52.1+/-11.6% at five years and 27.8+/-14.3% at eight years, compared with 55.6+/-16.6% at five years if the aortic valve was not resuspended using GRF glue.


CONCLUSIONS
The use of GRF glue to repair acute dissected aortic sinuses combined with the resuspension of the aortic valve is associated with an unacceptable incidence of failure of aortic valve repair and recurrence of aortic regurgitation. It may be more appropriate to resect all acute dissected aortic sinus tissue.
von Oppell
Ulrich O
UO
Department of Cardiothoracic Surgery, University of Cape Town, South Africa.
Karani
Zeead
Z
Brooks
Andre
A
Brink
Johan
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy*; D001011:Aorta / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy*; D001021:Aortic Valve / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004338:Drug Combinations; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005557:Formaldehyde / Q000627:therapeutic use*; D005780:Gelatin / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012118:Resorcinols / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin