The propensity for BioGlue to cause local inflammation, with myriad
resulting downstream issues, is widely reported in literature. It has
been suggested that polymerised BioGlue may continue to release
glutaraldehyde, which then exerts a cytotoxic effect on neighbouring
tissue, inducing inflammation, oedema, and possibly
necrosis.5 BioGlue-associated application site
inflammation is usually sterile and characterised by the presence of
inflammatory mediators with downstream clinical manifestations. In the
case of a 65-year-old female who developed pericardial effusion with
cardiac tamponade, following the use of BioGlue for ventricular
laceration repair, Babin-Ebell et al. noted sterile microbiological
findings, but with chronic granulomatous inflammatory infiltrate, likely
resulting from a foreign-material reaction to
BioGlue.13 Luk et al. also highlight two cases of
DeBakey type I aortic dissection involving BioGlue: islands of
inflammatory infiltrate (primarily macrophages, giant cells, and
lymphocytes) were identified around areas where BioGlue was applied to
aortic tissue.5 Further, BioGlue was also identified
as causing a large, sterile abscess with an inflammatory reaction around
the prosthetic aortic valve implanted in a patient with suspected
bacterial endocarditis.5 It is worth highlighting that
CryoLife warn against applying thick layers of BioGlue: this is said to
slow proteolytic degradation of the product, which may then precipitate
a sterile inflammatory response.7 In addition to
localised inflammatory responses, BioGlue has also been associated with
impaired aortic growth, nerve injury, and pseudoaneurysm formation.