The use of gelatin-resorcin-formalin glue in acute aortic dissection type A

Objectives: The Gelatin-resorcin-formalin (GRF) glue is widely used in the surgical treatment of dissecting aneurysms. This paper is focused on our ex perience with the GRF glue in cases, operated for acute aortic dissection t ype A. Methods: Between September 1990 and December 1997, 164 patients were operated on for acute aortic dissection type A. In 148 patients GRF was us ed to reinforce the dissected layers proximal (n = 106) or distal (n = 144) of the grafted aortic segment. An intervention at the aortic valve was nec essary in 93 instances. In ill patients, an open distal anastomosis for rep lacement of the proximal aortic arch was performed. Thirty-seven additional patients underwent subtotal or total aortic arch replacement. Results: Ear ly postoperative mortality was 26.2% (43/164 patients). Another 16 patients died late postoperatively. Actuarial survival rates are 69.9% at 1 year, 6 2.5% at 3 years, 59.4% at 5 years and 56.1% at 7 years, post-operatively. T wenty-two reoperations were performed in 20 patients (16.5%). Nine of these patients had developed complications in aortic segments that underwent rec onstruction by use of GRF during the primary intervention. Aortic root redi ssection was found in 7/9 patients intraoperatively, whereas 1/9 patients p resented with a rupture near the distal graft to aortic anastomosis. Conclu sions: The introduction of CRF glue has greatly facilitated the reconstruct ion of dissected aortic wall layers adjacent to the vascular graft. However , the use of the adhesive for aortic root reconstruction in acute aortic di ssection type A may bear a significant risk of late postoperative proximal aortic redissection. Complications associated with the GRF glue are likely to be due to the toxic effects of the formalin component. Therefore, care s hould be taken that the amount of formalin administered to the glue compone nts remains as low as possible. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.