THE PROPER USE OF GLUE - A 20-YEAR EXPERIENCE WITH THE GRF GLUE IN ACUTE AORTIC DISSECTION

Citation
J. Bachet et al., THE PROPER USE OF GLUE - A 20-YEAR EXPERIENCE WITH THE GRF GLUE IN ACUTE AORTIC DISSECTION, Journal of cardiac surgery, 12(2), 1997, pp. 243-253
Citations number
30
Categorie Soggetti
Cardiac & Cardiovascular System",Surgery
Journal title
ISSN journal
08860440
Volume
12
Issue
2
Year of publication
1997
Supplement
S
Pages
243 - 253
Database
ISI
SICI code
0886-0440(1997)12:2<243:TPUOG->2.0.ZU;2-V
Abstract
Background: In 1977, the use of Gelatine-Resorcine-Formaline (GRF) bio logical glue during surgery of acute Type A aortic dissection was prop osed. The present study retrospectively analyzes the tale results obta ined with this adjunct in an experience extending over a twenty-year p eriod of time. Patients and Methods: From January 1977 to March 1996, 171 patients (124 males and 47 females) aged from 15-79 years (mean ag e: 53 +/- 14 years) underwent an emergency operation for type A aortic dissection in our Institution. All patients suffered from acute type A dissection and 144 (84%) were operated on within 48 hours after the onset of symptoms. Twenty-six patients (15,2%) had Marfan's syndrome. The ascending aorta was replaced in all patients and the aortic stumps were reinforced with the GRF glue. In 39 patients (23%), the aortic v alve was replaced either independently (5 cases, 3%) or by means of a composite graft (34 cases, 19.8%). Because of the location of the inti mal tear, the aortic replacement was extended to the transverse arch i n 58 patients (33.9%). Results: Hospital mortality amounts to 21% (36 patients), 22.8% in patients with arch replacement and 21.1% in patien ts without arch replacement (n.s). One hundred thirty-five patients we re discharged and surveyed from 2 months to 19 years postoperatively ( cumulative follow-up: 856 patients/years. Mean follow-up: 79 +/- 66 mo nths). During this period of time, 22 patients (16.1%) had to be reope rated on for a total of 28 reoperations. Six of those (27.2%) died at reoperation. At univariate analysis, presence of Marfan's syndrome (p < 0.05) and absence of arch replacement (p < 0.02) were determinant ri sk factors for reoperation. Emergency (p < 0.01) and thoracoabdominal replacement (p < 0.04) were determinant risk factors of death at reope ration. The acturial freedom from reoperation (Kaplan-Meier, CI: 95%) is: 96.08% (90.9-98.2), 87.6% (79.8-92.7), 80.9% (70.8-88.1), 66.4% (5 1.1-78.9) at 1, 5, 10, and 15 years respectively. A total of 36 patien ts (27.7%) died during follow-up. Presence of Marfan's syndrome (p < 0 ,01), reoperation (p < 0.02), stroke (p < 0.05), cardiac failure (p < 0.05) were determinant risk factors of late mortality. The actuarial l ate survival rate (K-M. C.I.: 95%), including hospital mortality, is: 71.5% (64.3-77.8), 66% (58.3-73), 56.4% (47.7-64.7), 46.3% (36.4-56.5) at 1, 10 and 15 years. Conclusions: The GRF glue has proved to be ext remely useful during emergency initial surgery for acute type A dissec tion, making the procedure much easier and safer. Through this operati ve improvement, the use of the GRF glue seems to have a beneficial inf luence on the late results which however, depend mainly on the patient 's basic condition.