Use of BioGlue in Aortic Surgery: Proper Application Techniques and Results in 92 Patients


  • John W. Fehrenbacher
  • Harry Siderys



Background. Surgery for pathology of the proximal aorta requires aortic wall reconstruction, re-approximation of the graft to native vessels, and potentially root replacement and valve resuspension or replacement. The purpose of this study is to describe proper application techniques and the results obtained with the adjunctive use of BioGlue Surgical Adhesive in this challenging patient population.

Methods. Between August 1998 and June 2002, 92 consecutive patients underwent ascending/arch repairs, ascending/root repairs, Ross procedures, or ascending/arch repairs with a concomitant Ross procedure using BioGlue as an adjunct for anastomotic hemostasis.

Results. Twenty-six patients (28.3%) in this series required no postoperative blood products. The mortality rate for this single-surgeon series was 3.3%. No device-related complications were observed. The incidence rate for postoperative pseudoaneurysm formation was 3.3%.

Conclusions. This series demonstrates the safety and effectiveness of BioGlue as a hemostatic adjunct in proximal aortic surgery. Use of the product helped to facilitate a minimal reliance on blood products and a low mortality rate.


Bavaria JE, Brinster DR, Gorman RC, et al. 2002. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg 74:S1848-52.nBingley JA, Gardner MAH, Stafford EG, et al. 2000. Late complications of tissue glues in aortic surgery. Ann Thorac Surg 69: 1764-8.nCoselli JS, Bavaria JE, Fehrenbacher J, et al. 2003. Prospective randomized study of a protein-based tissue adhesive used as a hemostatic and structural adjunct in cardiac and vascular anastomotic repair procedures. J Am Coll Surg 197: 243-52.nDowning SW. 2003. Letter to the editor: what are the risks of using biologic glues? Ann Thorac Surg 75: 1063.nEnnker J, Ennker IC, Schoon D, et al. 1994. The impact of gelatin-resorcinol glue on aortic tissue: a histomorphological evaluation. J Vasc Surg 20: 34-43.nFink D, Klein JJ, Kang H, Ergin MA. 2004. Application of biological glue in repair of intracardiac structural defects. Ann Thorac Surg 77: 506-11.nFleck TM, Czerny M, Hutschala D, et al. 2003. The incidence of transient neurologic dysfunction after ascending aortic replacement with circulatory arrest. Ann Thorac Surg 76: 1198-1202.nFrist WH, Miller DC. 1986. Repair of ascending aortic aneurysms and dissections. J Card Surg 1: 33-52.nFukanaga S, Karch M, Harringer, et al. 1999. The use of gelatin-resorcinol-formalin glue in acute aortic dissection type A. Eur J Cardiothorac Surg 15: 564-70.nGoetz, Weissberg D, Hoppenstein R. 1966. Vascular necrosis caused by application of methyl 2-cyanoacrylate (Eastman 910 monomer): 7-months follow up in dogs. Ann Surg 163: 242-8.nGoldstein DJ, Beauford RB. 2003. Left ventricular assist devices and bleeding: adding insult to injury. Ann Thorac Surg 75:S42-7.nIslamoglu F, Posacioglu H, Apaydin AZ, et al. 2004. Perioperative determinants of mortality and morbidity in distal arch and proximal descending aortic aneurysm surgery. Med Sci Monit 10:CR137-42.nKazui T, Washiyama N, Bashar AH, et al. 2001. Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root. Ann Thorac Surg 72: 509-14.nKazui T. 2003. Reply to the editor: what are the risks of using biologic glues? Ann Thorac Surg 75: 1063-4.nLeMaire S, Won T, Wang X, et al. 2004. The threat of adhesive embolization: BioGlue leaks through anastomotic needle holes in aortic tissue and prosthetic grafts. Presented at the Society of Thoracic Surgeons 40th Annual Meeting, January 27.nMasroor S, Schor J, Carrillo R, Williams DB. 2004. Endoventricular pocket repair of type I myocardial rupture after mitral valve replacement: a new technique using pericardial patch, Teflon felt, and BioGlue. Ann Thorac Surg 77: 1439-41.nMejia R, Thomson DS. 2003. A new technique for repair of atrioventric-ular disruption complicating mitral valve replacement. Ann Thorac Surg 76: 1973-4.nNeiderhauser U, Kaplan Z, Kunzli A, et al. 1998. Disadvantages of local repair in acute Type A aortic dissection. Ann Thorac Surg 66: 1592-9.nPassage J, Jalali H, Tam RK, et al. 2002. BioGlue Surgical Adhesive—an appraisal of its indications in cardiac surgery. Ann Thorac Surg 74: 432-7.nStrauch JT, Spielvogel D, Lauten A, et al. 2004. Technical advances in total arch replacement. Ann Thorac Surg 77: 581-9.nUeda T, Shimizu H, Hashizume K, et al. 2003. Mortality and morbidity after total arch replacement using a branched arch graft with selective antegrade cerebral perfusion. Ann Thorac Surg 76: 1951-6.nWeissberg D, Goetz RH. 1964. Tissue reactions to methyl-2-cyanoacry-olate (Eastman 910 monomer). Surg Forum 15: 226-7.nWeissberg D, Goetz RH. 1964. Necrosis of arterial wall following application of methyl-2-cyanoacrylate. Surg Gynecol Obstet 119: 1248-52.nWestaby S, Saito S, Katsumata T. 2002. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg 73: 707-13.nYoshitatsu M, Fumikazu N, Katayama A, et al. 2004. Pathologic findings of aortic redissection after glue repair of proximal aorta. J Thorac Car-diovasc Surg 127: 593-5.n



How to Cite

Fehrenbacher, J. W., & Siderys, H. (2006). Use of BioGlue in Aortic Surgery: Proper Application Techniques and Results in 92 Patients. The Heart Surgery Forum, 9(5), E794-E799.