4.2: Is BioGlue priming to prevent graft oozing safe?
The exposure of lysine molecules presents in both the BSA component and
the ECM of the target tissue to the glutaraldehyde component of BioGlue
results in the formation of covalent bonds between lysine molecules;
this creates a strong scaffold to reinforce anastomoses, and to aid
close of the false lumen (FL).11 In this regard,
BioGlue is a profoundly useful tool: 65% of its final binding power is
reached within 20 seconds, and maximal strength is reached within two
minutes, regardless of temperature or exposure to
water.11 BioGlue has been associated with reduced
anastomotic bleeding, as well as reduced total blood loss, circulatory
arrest duration, procedure duration, and overall length of
stay.1 Typically, 5 mL is sufficient for most
applications in cardiac and aortic procedures.11
Ho and colleague’s method for priming the FET prosthesis with BioGlue
prior to resumption of blood flow is straightforward and involves
application of the glue to the outer surface of the graft using the
delivery syringe.8 Two vials of BioGlue were
reportedly used for fabric priming, however slight, residual (albeit
potentially benign) oozing from the graft persisted once blood flow
resumed.8 Priming reportedly allowed the patient to be
safely weaned off CPB with a systolic blood pressure of 120
mmHg.8
At this juncture, it is crucial to note that though BioGlue is safe and
effective in its usual applications, several well-documented adverse
effects and added risks call into question the long-term safety of using
BioGlue priming to mitigate oozing risk.5 Perhaps more
significantly, the need for the generous application of a potentially
harmful substance to the aortic graft, brought about by inherent
shortcomings in device design, calls into question the overall safety
and suitability of E-Vita Open NEO. This is more striking when one
recalls that evidence of improved clinical efficacy of E-Vita Open NEO
compared to other, non-oozing grafts such as Thoraflex HP, is both
sparse and varied.