4. DISCUSSION
Oozing from the polyester segment of the frozen elephant trunk (FET)
prosthesis is undoubtedly a worrying and potentially catastrophic
challenge that seemingly may occur in the absence of technical error.
Alarmingly, Ho et al. note that such a complication should be ‘expected’
during implantation of E-Vita Open NEO.8 Figures 1 and
2 depict visually the extent of the oozing that may occur – within 30
seconds of pressurisation, oozing was sufficient for streams of blood
along the outer surface of the graft to form, and eventually 250 mL of
blood was lost within 1 min of pressurisation. Subsequent investigations
revealed that a considerable amount of BioGlue was required to
impregnate the entirety of E-Vita Open NEO. Impregnation of a 1 mm coat
of BioGlue required 43.694 mL of BioGlue (amounting to five 10 mL
syringes) while the graft was not under tensile stress. It would be
reasonable to suggest that a greater volume yet of BioGlue would be
needed to coat a fully expanded FET graft of this type. For reference,
the amount of BioGlue applied in cases such as aortic root replacement,
graft-aorta anastomosis etc. rarely exceeds 5 mL.11Priming of E-Vita Open NEO to prevent oozing therefore demands far more
BioGlue than usual.