Type A acute aortic dissection: immediate and mid-term results of emergency aortic replacement with the aid of gelatin resorcin formalin glue.
BACKGROUND
The aim of this study was to assess the mid-term results of operation for type A acute aortic dissection with the aid of gelatin resorcin formalin glue.


METHODS
Emergency operation was carried out in 84 patients during the last 8 years. Fifty-five patients (65.5%) had mild-to-moderate aortic regurgitation. Gelatin resorcin formalin glue was applied to both the proximal and distal aortic stumps. We evaluated the presence of aortic regurgitation and the patency of the distal false lumen at the time of this study. The survival and reoperation-free rates were also assessed. In case of late reoperation, aortic wall samples of the glued area were examined histologically.


RESULTS
Ascending to hemiarch replacement were performed in 71 patients (84.5%). Total aortic arch and root replacement were required in 13 and 7 patients, respectively. Overall hospital mortality was 6.0% (5 patients). Late death was observed in 12 patients (14%). Reoperation for redissection in the aortic root, development of aortic regurgitation, and enlargement of the distal false lumen occurred in 1, 3, and 1 patient, respectively. Histologic examination showed no evidence of infiltration of inflammatory cells in the glued area. Computed tomography scan revealed a patent distal false lumen in 8 (14%) of 58 patients. Echocardiography detected moderate aortic regurgitation in 2 patients. The actuarial survival rate at 1, 5, and 8 years was 85.5%, 80%, and 60.0%, respectively. The reoperation-free rate at 8 years was 89%.


CONCLUSIONS
The results of emergency aortic replacement with gelatin resorcin formalin glue have shown reasonable early and late mortality and reoperation rates. There was no histologic evidence of adverse tissue reactivity by gelatin resorcin formalin glue.
Hata
Mitsumasa
M
The Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan. mihata@med.nihon-u.ne.jp
Shiono
Motomi
M
Sezai
Akira
A
Iida
Mitsuru
M
Negishi
Nanao
N
Sezai
Yukiyasu
Y
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D018572:Disease-Free Survival; D004338:Drug Combinations; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005557:Formaldehyde; D005780:Gelatin; D006801:Humans; D008297:Male; D008875:Middle Aged; D012118:Resorcinols; D015996:Survival Rate; D014014:Tissue Adhesives; D016896:Treatment Outcome
D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin