Role of bovine serum albumin-glutaraldehyde glue in the formation of anastomatic pseudoaneurysms.
BACKGROUND
Questions exist concerning the safety of bovine serum albumin-glutaraldehyde (BSAG) glue in thoracic aortic surgery, vis-à-vis embolization and pseudoaneurysm formation. We examined clinical experience with BSAG glue to determine if such problems were detected.


METHODS
We studied 99 consecutive patients (25 female and 74 male, age range 27 to 86 years) in whom BSAG glue or similar product was used for reinforcement of thoracic aortic suture lines (n = 87 BSAG glue, 12 GRF [French] glue). BSAG glue was used selectively and sparingly for acute aortic dissection or tissue fragility. Cases included 81 ascending/arch procedures, 15 descending/thoracoabdominal procedures, and 3 combined. Clinical outcome and postoperative computed tomography (CT) scans were reviewed. Follow-up ranged from 1 to 90 months (mean: 15.1 months). We also examined the records of 78 controls in which BSAG glue was not used. The two groups were statistically similar except for rate of aneurysm versus dissection and percentage of emergent surgery.


RESULTS
Perioperative survival was 95/99 (96.0%). Six patients (6.0%) required reexploration for bleeding. There were five early postoperative neurological events and no late strokes or peripheral embolic events. CT scan follow-up identified two pseudoansuerysms, both not perianastomic, which were likely unrelated to BSAG glue use. There was no statistically significant difference in the occurrence of pseudoaneurysms between the two groups.


CONCLUSIONS
Isolated problems associated with BSAG glue have been reported. In this relatively large experience, we identified no obvious problems directly related to judicious use of BSAG glue. BSAG glue appears a safe and effective adjunct in thoracic aortic surgery.
Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Joshua
J
Weiner
Shannon
S
Widman
Zygmunt
Z
Golek
Maryann
M
Tranquilli
John A
JA
Elefteriades
D000208:Acute Disease; D000269:Adhesives / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D017541:Aneurysm, False / Q000453:epidemiology / Q000209:etiology*; D000818:Animals; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery; D002417:Cattle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005976:Glutaral / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012710:Serum Albumin, Bovine / Q000009:adverse effects*; D014014:Tissue Adhesives / Q000009:adverse effects*; D014656:Vascular Surgical Procedures
D000269:Adhesives; D014014:Tissue Adhesives; D012710:Serum Albumin, Bovine; D005976:Glutaral