4.2.2: Effect of BioGlue on surrounding tissues
LeMaire et al. investigated, using a porcine model, the effect of BioGlue on aortic growth. It was found that aortic growth was attenuated in piglets assigned to undergo anastomotic reinforcement of the aorta with BioGlue, and that those piglets also developed 33.9% stenosis of the aortic lumen and adventitial changes reflective of tissue fibrosis (P = 0.038 and P = 0.008 respectively).4 LeMaire et al. in 2005 also concluded that BioGlue harmed nerve and cardiac conduction tissue via direct contact. Considering the proximity of the FET prosthesis to the recurrent laryngeal nerve, the risk of causing non-mechanical, irreversible recurrent laryngeal nerve palsy by liberal application of BioGlue must be considered. Mechanical valve obstruction, bypass graft stenosis, pulmonary embolism, and cardiac tamponade are further examples (albeit rare) of complications associated with BioGlue use.13,14,15The effect of BioGlue hardening on surrounding tissues is also worthy of consideration. Azadani et al. found BioGlue to exhibit the most stiffness compared to other commercially available alternatives (P < 0.001), and though they rightly point out that this may reduce the risk of arterial stretching and eventual pseudoaneurysm formation in vessels strengthened with BioGlue, it could be argued that BioGlue priming of E-Vita Open NEO may stiffen the graft, making reintervention difficult and dangerous.16 Leone et al. cite reintervention rates for thoracic aortic aneurysms as being as high as 39.6%, and 23.7% for aortic arch dissection.17Considering these high rates of reintervention, is hardening of the graft surface with BioGlue the best long-term option?