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Devastating late complication for repair of type A acute aortic dissection with usage of gelatin-resorcinol-formalin glue

Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center, 3-1 Aoyama-cho, Kure, Hiroshima 737-0023, Japan

*Corresponding author. Tel.: +81-0823-22-3111; fax: +81-0823-21-0478.

E-mail address: izutani{at}kure-nh.go.jp (H. Izutani).

Objectives: We review cases of pseudoaneurysm formation of the graft anastomosis sites following repair of type A acute aortic dissection by our original leak-proof technique for dissected aortic wall reinforcement with xenopericardium and gelatin-resorcinol-formalin (GRF) glue. Cases: A 47-year-old male presented inferior acute myocardial infarction with bradycardia and cardiogenic shock 34 months after the initial total arch replacement for acute aortic dissection. The patient underwent reoperation with total arch replacement and coronary artery bypass grafting to the right coronary artery. There was rupture of the proximal anastomosis with clotted pseudoaneurysm formation extending over the right ventricle. The right coronary artery was compressed by the pseudoaneurysm. The distal anastomosis also ruptured with localized pseudoaneurysm formation. Twenty-two patients with type A acute aortic dissection underwent aortic repair by our original leak-proof technique for dissected aortic wall reinforcement with xenopericardium and gelatin-resorcinol-formalin glue between 1997–2003. Four patients developed redissection of the anastomosis sites, which required reoperation, including the current case. Discussion: The cause of redissection was unclear, however, use of GRF glue itself might develop tissue damage and redissection of the aorta, and also glued xenopericardium strip reinforcement in our original technique might accelerate damage to the aortic wall. Conclusion: Follow-up examination is mandatory for the patient of aortic repair with the use of GRF glue.

Key Words: Aortic dissection; Aortic operation; Reoperation

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