Department of Cardiology, University of Toronto, Toronto, Ontario, Canada.
J Clin Pathol. 2012 Nov;65(11):1008-12. doi: 10.1136/jclinpath-2012-200809. Epub 2012 Aug 7.
Bioglue is an adhesive used during cardiovascular surgery to improve hemostasis perioperatively and to strengthen and reinforce vascular anastomoses. It has also been used to 'seal' the false lumen in patients presenting with acute aortic dissections. Herein, we examine the complications of Bioglue, which may lead to redo sternotomy in selected patients.
A review of pathology records at our institution from 2002 to 2010 found 4 cases of excised aortic tissue and/or aortic valves with previous Bioglue use at initial operation. Excised tissues and valves were examined, looking for the presence of Bioglue, inflammatory cells (acute, chronic, macrophage and giant cells) and micro-organisms. Patient demographics were also reviewed and recorded.
We identified four cases of Bioglue use found at redo surgery, after the formation of pseudoaneurysm (n=3) and aortic stenosis (n=1). Mean interval to redo surgery was 2.28 + 0.32 years (range 2-2.6 years). Pseudoaneurysm formation was thought to be caused by an inflammatory reaction to the Bioglue itself in two cases, while one case found no such reaction. One patient with previous aortic valve replacement had large annular abscesses filled with necrotic debris surrounding the prosthesis and pannus found on the sewing cuff, comprised of Bioglue itself.
The mechanisms leading to these complications include mechanical strain, inflammation and tissue necrosis. The judicious use of Bioglue when clinically indicated, and close follow-up of these patients with serial imaging, remain an integral part of avoiding future complications.
生物胶是一种在心血管手术中使用的粘合剂，可改善围手术期的止血效果，并加强和增强血管吻合。它也被用于在急性主动脉夹层患者中“密封”假腔。在此，我们检查了生物胶的并发症，这些并发症可能导致某些患者需要再次进行胸骨切开术。
我们对 2002 年至 2010 年我院的病理记录进行了回顾，发现 4 例在初次手术中使用过生物胶的切除主动脉组织和/或主动脉瓣。检查切除的组织和瓣膜，寻找生物胶、炎症细胞（急性、慢性、巨噬细胞和巨细胞）和微生物的存在。还回顾并记录了患者的人口统计学资料。
我们在再次手术中发现了 4 例使用生物胶的病例，其中 3 例形成假性动脉瘤，1 例形成主动脉瓣狭窄。再次手术的平均间隔时间为 2.28 + 0.32 年（范围 2-2.6 年）。在两种情况下，假性动脉瘤的形成被认为是对生物胶本身的炎症反应引起的，而在一种情况下则没有发现这种反应。一位有先前主动脉瓣置换术的患者，其瓣环周围有大的脓肿，充满了围绕假体的坏死碎片和瓣叶上的肉芽组织，其中包含生物胶本身。
导致这些并发症的机制包括机械应变、炎症和组织坏死。在临床需要时明智地使用生物胶，并对这些患者进行密切随访，进行连续影像学检查，仍然是避免未来并发症的重要组成部分。
