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?