Eur J Cardiothorac Surg 2005;27:532
© 2005 Elsevier Science NL
Reply to Mastroroberto et al.
J. Andreas Hoschtitzkya,*,
Louise Crawforda,
Mick Brackb,
John Aua
a Department of Cardiothoracic Surgery, Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NR, UK
b Department of Cardiology, Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NR, UK
Received 15 December 2004;
accepted 17 December 2004.
* Corresponding author. Address: Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. Tel.: +44 161 276 4271; fax: +44 161 276 8522. (E-mail: ahoschtitzky{at}yahoo.com).
Key Words: Great vessels • Coronary disease • Myocardial infarct
We would like to thank Mastroroberto and colleagues for their comments on our paper [1]. Their described experience with gelatin–resorcin–formalin (GRF) glue in the surgical treatment of acute type A aortic dissection is interesting. As they rightly state, despite Hata's recent findings [2] on the significant survival benefits of using GRF glue in the treatment of aortic dissection, its' use does have complications. GRF glue has been associated with destruction of the aortic media, causing thinning of the vessel wall and rupture [3]. It has also been associated with migration and embolisation to the brain [4] and coronary ostial stenosis. Even though Bioglue is supposed to be less toxic than GRF glue, it is also more liquid and potentially more likely to reach the vessel lumen. Therefore, it could theoretically embolise. Coronary embolisation of Bioglue after aortic dissection repair in the early post-operative period, was one of a few possible causes of the clinical picture we encountered in our case [1]. Mahmood and colleagues [5] describe a similar case with unfortunately fatal outcome. In their case, Bioglue had embolised to both left and right coronary arterial trees as shown by post-mortem, causing fatal right ventricular dysfunction. Biological glue should therefore be used with caution. As to the subject of pre-operative angiography, we agree with Mastroroberto and colleagues that it may be detrimental to the patient in most cases. We feel it may only be indicated in those cases when the patient is haemodynamically stable and a very high index of suspicion of coronary artery disease is present.
References
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- Hata M, Shiono M, Sezai A, Iida M, Negishi N, Sezai Y. Type A acute aortic dissection: immediate and mid-term results with the aid of gelatin resorcin formalin glue. Ann Thorac Surg 2004;78:853-857.[Abstract/Free Full Text]
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- Mastroroberto P, Chello M. Embolisation of biological glue after repair of acute aortic dissection. Ann Thorac Surg 1996;62:946-947.[Free Full Text]
- Mahmood Z, Cook DS, Luckraz H, O'Keefe P. Fatal right ventricular infarction caused by Bioglue coronary embolism. J Thorac Cardiovasc Surg 2004;128:770-771.[Free Full Text]
