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Eur J Cardiothorac Surg 2005;27:531-532
© 2005 Elsevier Science NL
Letter to the Editor |
a Department of Experimental and Clinical Medicine, Cardiovascular Surgery Unit, University Magna Graecia, Via T. Campanella 115, 88100 Catanzaro, Italy
b Cardiovascular Surgery Unit, University Campus BioMedico, Rome, Italy
Received 11 November 2004; accepted 17 December 2004.
* Corresponding author. Tel./fax: +39 961 712307. (E-mail: mastroroberto{at}unicz.it).
Key Words: Aortic dissection • Biological glue • Embolisation
We read with great interest the case report presented by Hoschtitzky and co-workers on a patient with acute coronary syndrome following repair of aortic dissection [1] and we would like to present our personal experience on pathologic findings after glue repair of the proximal aorta to add further informations on this field. My collegues and I have started the routine utilization of gelatine resorcin formalin glue (GRF) in the treatment of type A aortic dissection in 1994 on a consecutive series of 66 patients and in all cases the dissected aorta was completely resected preparing the two cuffs with GRF to obliterate the false lumen (we underline that the glue was applied just in the aortic wall dissected not in the depth of the false lumen) and external strips of Teflon felt to reinforce the wall, and then sutured to a vascular graft. The aortic valve was replaced in two patients and preserved in the remaining cases.
The overall hospital mortality was 18.2% (12/66). The contrast-enhanced computed tomography performed at follow-up demonstrated the presence of patent distal false lumen in six patients.
One patient died 15 days after the operation with the evidence at the autopsy of a point of reentry of the dissection into the true lumen at the origin of the innominate artery together with the presence of particles of polymerised glue in the false lumen and multiple small cerebral lesions as ischemic infarction. The presence of inflammatory reaction and signs of wall weakness has been found in one reoperation: in this case the presence of redissection was evident in both proximal and distal suture lines.
On the basis of our 10-year experience on surgical emergency treatment of acute type A aortic dissection the results using GRF glue are encouraging, but not so enthusiastic as recently reported by Others [2]. It is evident in Literature that preoperative cardiac tamponade, renal failure and neurological alterations must be considered as independent risk factors for mortality irrespectively from the use of a biological glue and the persistence of a false lumen with consistent risk of redissection is related to the preoperative anatomical findings. The incidence of a persistent patent false lumen lead us a little caution on the analysis of all results that report low operative mortality, low postoperative complications, high freedom from reoperation related to a single factor as the correlation between GRF and pathophysiological findings of inflammation and/or necrosis causing aortic redissection.
We agree with the Authors of the article presented in the recent number of the European Journal [1] that the acute obstruction of the left anterior descending artery probably is strictly related to embolisation of fragment of glue (Bioglue) and, on the other hand, we believe that a preoperative coronary angiography in absence of a pre-existent and documented coronary disease is more dangerous than helpful.
Finally, we are grateful to Hoschtitzky and associates for the opportunity of a further and useful debate of an old disease that continuously presents new insights.
References
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