Surgery

Cardiac Surgery Techniques Aorta Repair with Glue Bioglue



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BioGlue is a surgical adhesive that is made from two different components. It has purified bovine serum albumin, otherwise known as BSA, as well as glutaraldehyde. Scientists and doctors obtain the BSA from cattle in countries that do not use bovine spongiform encephalopathy (BSE). This substance goes through various processes that reduces the amount of viruses contained within it and deactivates other viruses. This is to promote and ensure certain levels of safety for its use.

When the components of BioGlue are combined in the correct proportions, they are packaged very carefully in containers that are created for easy dispensation. Once the glue has been placed on the area in question, such as the aorta, there is a cross-link formed with the molecules. It blends with the tissue proteins which then produces a flexible seal that is not dependent upon the body’s system of clotting.

The glue has fast results. It polymerizes (creates three-dimensional networks) within 30 seconds and it reaches full bonding strength within two minutes of application. BioGlue is meant to be used during the surgical repair of the aorta, or other major blood vessels, in addition to the use of staples or sutures. BioGlue does not replace these instruments.

There are various applications for this glue including sealing the areas around stitches or sutures during various surgical procedures. One major use as stated in various studies including that of the Sheba Medical Center include repairing the aorta after it has dissected.

Aortic Dissection

The aorta is the main blood vessel that carries blood from the heart to the rest of the organs in the body. It has branches to supply blood to the arms and legs as well as every other place to ensure adequate blood flow. When there is a dissection in the aorta, it means that there is a tear in the inner layer of the wall of this vessel.

Blood has the ability to enter into this tear, stripping this layer away from the middle layer. This divides the layers of muscles in the wall of the aorta. There are cases where the dissection occurs through all three layers. This can cause an immediate rupture of the vessel. However, this is uncommon as most tears are between only two.

Treatment

In the past there have been two main treatments for the repair of the aorta. The first stages include medication to control blood pressure. This helps to prevent the tear from becoming worse. Further types of treatment depend on the placement of the dissection.

When the dissection is near the ascension of the aorta, there is extreme high risk involved. Surgery is required for this and there is a 30% mortality rate even with treatment. The other type of dissection is that of the descending aorta for which non-surgical procedures are preferred.

Individuals who experience a dissection through all three layers only have 20% change of survival. Half of the patients do not live through the trip to the hospital due to the rupture.

Adding BioGlue as a Treatment Option

BioGlue has changed the way that the procedures are done as well as the rate of further treatments required by patients. The glue being added to the dissection of the aorta makes the body tissue stronger for sewing it together. The bond is therefore also stronger.

In a study completed by the Sheba Medical Center, they showed that as of 2004, ten percent of patients passed away after having this treatment while the remainder went on to live healthier lives. They did not require extra treatment, repair, or surgery for the next sixteen months. There were no signs of aorta insufficiency, aorta rupture or recurring dissection.

Further Studies

There are ongoing studies on the use of BioGlue as an option for treatment on aortic dissection and other conditions. So far, there have been no issues brought up against its use that have been substantiated. According to the results of patients, not only have most applications been successful, but they are more successful than surgical procedures completed without its use.


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ARTICLE SOURCES AND CITATIONS
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