Nerve and conduction tissue injury caused by contact with BioGlue.
BACKGROUND
BioGlue-a surgical adhesive composed of bovine albumin and glutaraldehyde-is commonly used in cardiovascular operations. The objectives of this study were to determine whether BioGlue injures nerves and cardiac conduction tissues, and whether a water-soluble gel barrier protects against such injury.


METHODS
In 18 pigs, diaphragmatic excursion during direct phrenic nerve stimulation was measured at baseline and at 3 and 30 min after nerve exposure to albumin (n = 3), glutaraldehyde (n = 3), BioGlue (n = 6), or water-soluble gel followed by BioGlue (n = 6). Additionally, BioGlue was applied to the cavoatrial junction overlying the sinoatrial node (SAN), either alone (n = 12) or after application of gel (n = 6).


RESULTS
Mean diaphragmatic excursions in the BioGlue and glutaraldehyde groups were lower at 3 min and 30 min than in the albumin group (P < 0.05). Mean excursions in the gel group were similar to those of the albumin group (P = 0.9). Five BioGlue pigs (83%) and one gel pig (17%) had diaphragmatic paralysis by 30 min (P < 0.05 and P = 0.3 versus albumin, respectively). Coagulation necrosis extended into the myocardium at the cavoatrial junction in all 12 BioGlue pigs but only two gel pigs (33%, P < 0.01). Two BioGlue pigs (17%), but no gel pigs, had focal SAN degeneration and persistent bradycardia (P < 0.01).


CONCLUSIONS
BioGlue causes acute nerve injury and myocardial necrosis that can lead to SAN damage. A water-soluble gel barrier is protective.
Lemaire
Scott A
SA
Cardiovascular Surgery Service, the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA. slemaire@bcm.edu
Ochoa
Lyssa N
LN
Conklin
Lori D
LD
Schmittling
Zachary C
ZC
Undar
Akif
A
Clubb
Fred J
FJ
Li Wang
Xing
X
Coselli
Joseph S
JS
Fraser
Charles D
CD
D000418:Albumins / Q000494:pharmacology; D000818:Animals; D002921:Cicatrix / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005976:Glutaral / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D009336:Necrosis; D009431:Neural Conduction / Q000187:drug effects*; D010791:Phrenic Nerve / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology*; D011506:Proteins / Q000633:toxicity*; D012849:Sinoatrial Node / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D034421:Sus scrofa
D000418:Albumins; C472676:Bio-glue; D011506:Proteins; D005976:Glutaral