Aortic root necrosis after surgical treatment using gelatin-resorcinol-formaldehyde (GRF) glue in patients with acute type A aortic dissection.
BACKGROUND
Although gelatin-resorcinol-formaldehyde (GRF) glue is used for surgical repair of acute type A aortic dissections, late complications possibly ascribed to toxic effects of GRF glue have been reported. We analyzed the benefits and risks of using GRF glue.


METHODS
Between January 1990 and August 2003, 269 consecutive patients underwent emergency operations for acute type A aortic dissection. GRF glue was not used in 47 patients (non-GRF group) who were operated on until May 1995 and was used in the 222 (GRF group) who underwent operation subsequently.


RESULTS
The rate of in-hospital mortality was significantly higher in the non-GRF group (31.9%) than in the GRF group (12.6%) (p<0.0001). In the GRF group, false aneurysms were found in 31 patients (31/194 survivors, 16.0%) 1-65 (mean, 30+/-18) months after initial operation. Reoperation was done in 24 of these patients. At reoperation, the site to which GRF glue was applied had degenerated, and the anastomosis between the aortic root and prosthesis had opened widely, creating a false aneurysm and resulting in aortic regurgitation with prolapse of the coronary cusps. The mortality rate of reoperation was 4.2% (1/24).


CONCLUSIONS
The use of GRF glue improved the short-term outcome of surgery for acute type A aortic dissection, but was associated with a high incidence of false aneurysms forming at the site of proximal anastomosis, where GRF glue had been applied. Patients in whom GRF glue has been used should be carefully followed up after surgery.
Suzuki
Shinichi
S
Department of Cardiovascular Surgery, Yokohama City University School of Medicine, Cardiovascular Center, Yokohama, Kanagawa, Japan.
Imoto
Kiyotaka
K
Uchida
Keiji
K
Takanashi
Yoshinori
Y
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000187:drug effects / Q000473:pathology*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005557:Formaldehyde / Q000009:adverse effects*; D005780:Gelatin / Q000009:adverse effects*; D005976:Glutaral / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000139:chemically induced / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012118:Resorcinols / Q000009:adverse effects*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods
D004338:Drug Combinations; D012118:Resorcinols; C083703:gelatin-resorcin-formaldehyde-glutaraldehyde adhesive; D005557:Formaldehyde; D005780:Gelatin; D005976:Glutaral