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Prevention vs. Cure: is BioGlue priming the optimal strategy against E-Vita Neo graft oozing?
  • Cian Tan,
  • Mohamad Bashir
Cian Tan
Queen Mary University of London Barts and The London School of Medicine and Dentistry
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Mohamad Bashir
NHS Wales Health Education and Improvement Wales
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Abstract

Background Since the introduction of the E-Vita Open NEO aortic prosthesis in 2020, several incidences of post-anastomotic oozing from the polyester portion of the graft have emerged. The use of BioGlue to prime E-Vita Open NEO to prevent this has been suggested as a way to mitigate this worrying complication. We investigate the extent of graft oozing in E-Vita Open NEO and evaluate the use of BioGlue in preventing oozing, both experimentally and in terms of potential clinical complications. Methods and materials E-Vita Open NEO (in straight and branched configurations) was implanted in a perfused model. The distal stent-graft and side branches were clamped, and the graft pressurised with blood to 120 mmHg. The volume of blood (ml) oozing from the graft within 60 seconds was measured. Non-pressurised grafts were coated with BioGlue up to a thickness 1-, 2-, and 3 mm, and the volume (mm3) of BioGlue required to do so was recorded. Results Within 60 seconds, 250.0 ml of blood oozed from the grafts tested. 43.694 mm3, 87.389 mm3, and 174.778 mm3 of BioGlue was required to coat the device with 1-, 2-, and 3 mm of BioGlue. Conclusion Graft oozing from E-Vita Open NEO represents an omnipresent and worrying risk. The use of BioGlue herein is likely associated with several adverse consequences, which are an additional risk on top of that posed by graft oozing. These risks call into question the suitability of E-Vita Open NEO, especially when compared to alternative devices not affected by oozing.

Peer review status:ACCEPTED

22 Oct 2021Submitted to Journal of Cardiac Surgery
22 Oct 2021Assigned to Editor
22 Oct 2021Submission Checks Completed
22 Oct 2021Reviewer(s) Assigned
25 Oct 2021Review(s) Completed, Editorial Evaluation Pending
25 Oct 2021Editorial Decision: Accept