Late complications of gelatin-resorcin-formalin glue in the repair of acute type A aortic dissection.
BACKGROUND
During surgical treatment for acute type A aortic dissection, gelatin-resorcin-formalin glue is generally applied and its efficacy has been reported. However, some late complications that are potentially associated with this glue have also been reported. In the present study, we reviewed our experiences of treatment for acute type A aortic dissection and late complications that occurred in the anastomotic site, which needed a reoperation.


METHODS
From October 1994 to August 2005, 68 patients underwent emergency surgery for acute type A aortic dissection. Gelatin-resorcin-formalin glue was applied to 56 (82.4%) of these patients at one or both of the distal and proximal anastomosis sites.


RESULTS
Eight (11.8%) patients died in hospital within 30 days after the operation, among which two patients already had cerebral complications prior to the surgery. There were five late deaths from causes unrelated to cardiac events. Five patients developed an aortic pseudoaneurysm at the anastomotic site and underwent a late reoperation. All of these patients had been treated with gelatin-resorcin-formalin glue during the previous operation. Histologic examination of the resected aortic wall after the reoperation revealed tissue necrosis, severe local inflammation, and organization of old thrombi at the site of the glue application.


CONCLUSIONS
Late complications after the use of gelatin-resorcin-formalin glue may occur with a certain amount of risk, suggesting its toxicity for aortic tissue. Therefore, proper use of this glue and close follow-up of the patients are strictly required.
Hata
Hiroki
H
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Takano
Hiroshi
H
Matsumiya
Goro
G
Fukushima
Norihide
N
Kawaguchi
Naomasa
N
Sawa
Yoshiki
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D004338:Drug Combinations; D005260:Female; D005557:Formaldehyde / Q000009:adverse effects*; D005780:Gelatin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012118:Resorcinols / Q000009:adverse effects*; D013997:Time Factors; D014014:Tissue Adhesives / Q000009:adverse effects*
D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin