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.