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.