Surgery of type A acute aortic dissection with Gelatine-Resorcine-Formol biological glue: a twelve-year experience.

Gelatine-Resorcine-Formol Glue has been proposed to reinforce the tissues during surgery of type A acute aortic dissection. From January 1977 to December 1988, 105 patients were operated on in emergency. The ascending aorta was replaced in all patients and the aortic stumps were reinforced with the GRF glue before suturing a Dacron prosthesis. In 29 patients the repair extended to the aortic arch. In these cases, the distal repair was carried out under circulatory arrest and profound hypothermia (21 patients) or carotid perfusion (8 patients). The aortic valve was replaced in 20 patients (20%). Four patients died during surgery and 20 patients died during the postoperative course for an overall hospital mortality rate of 23%. Average follow-up is 51 months (range: 3 to 130 m). Three patients were lost to follow-up. Seven patients died 3 months to 10 years postoperatively. Eleven patients had to be reoperated upon for AVR (3 patients), CABG (1 patient) and recurring or evolving dissecting aneurysm (8 patients). The reoperations resulted in 2 deaths. The remaining 69 patients are in good or fair clinical condition. Postoperative angiograms, CT scans or NMR, have shown a satisfactory repair in all documented patients but a persisting dissection beyond the prosthesis in 75% of them. The GRF glue allows easier and safer repair of type A acute dissection. It has permitted the extension of the repair to the aortic arch whenever necessary.