OBJECTIVE: We present two cases of type A aortic dissection repaired with the help of biological glue, that were followed by acute limb ischemia due to embolism of glue. METHODS AND RESULTS: A 30-year-old man was diagnosed with aortic dissection from left coronary sinus to right subclavian artery. Under deep hypothermic circulatory arrest (DHCA), distal aortic anastomotic site was reconstructed with injection of Bioglue between dissected layers, and a valve sparing inclusion technique was performed using a straight dacron graft. On postoperative day 14, he presented acute limb ischemia due to femoral artery glue embolism that required surgery. A 76-year-old woman with the diagnosis of type A dissection ending proximal to the celiac trunk was operated under cardiopulmonary bypass and DHCA. The ascending aorta was replaced with a straight dacron tube, with resuspension of aortic valve and reinforcement of proximal and distal anastomosis with Bioglue between the diseased layers. Absence of previously patent radial pulse was detected intraoperatively, solved with humeral thromboembolectomy. CONCLUSIONS: Management of the diseased aortic wall in acute dissections is a surgical challenge for the cardiac surgeon. Despite our group having a positive experience with biological glue in type A aortic dissection, this report reminds us that the use of bioadhesives to reinforce anastomotic sites may be an important tool but it is not free of problems.
OBJECTIVE: We present two cases of type A aortic dissection repaired with the help of biological glue, that were followed by acute limb ischemia due to embolism of glue. METHODS AND RESULTS: A 30-year-old man was diagnosed with aortic dissection from left coronary sinus to right subclavian artery. Under deep hypothermic circulatory arrest (DHCA), distal aortic anastomotic site was reconstructed with injection of Bioglue between dissected layers, and a valve sparing inclusion technique was performed using a straight dacron graft. On postoperative day 14, he presented acute limb ischemia due to femoral artery glue embolism that required surgery. A 76-year-old woman with the diagnosis of type A dissection ending proximal to the celiac trunk was operated under cardiopulmonary bypass and DHCA. The ascending aorta was replaced with a straight dacron tube, with resuspension of aortic valve and reinforcement of proximal and distal anastomosis with Bioglue between the diseased layers. Absence of previously patent radial pulse was detected intraoperatively, solved with humeral thromboembolectomy. CONCLUSIONS: Management of the diseased aortic wall in acute dissections is a surgical challenge for the cardiac surgeon. Despite our group having a positive experience with biological glue in type A aortic dissection, this report reminds us that the use of bioadhesives to reinforce anastomotic sites may be an important tool but it is not free of problems.
Authors: Tony Vuocolo; Roger Haddad; Glenn A Edwards; Russell E Lyons; Nancy E Liyou; Jerome A Werkmeister; John A M Ramshaw; Christopher M Elvin Journal: J Gastrointest Surg Date: 2011-11-12 Impact factor: 3.452