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
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.