Recommendation for appropriate use of GRF glue in the operation for acute aortic dissection

Because an excessive use of activator (formaldehyde + glutaraldehyde) is supposed to be responsible for later adverse events after the use of gelatin resorcin formalin (GRF) glue in surgery for acute aortic dissection, we have tried to use a minimum dose of activator when the GRF glue was applied. We compare our midterm surgical results for acute aortic dissection with and without the use of GRF glue.

Forty-nine consecutive operated cases with Stanford type A acute aortic dissection within 48 h from onset from 1992 to 2005 were retrospectively analyzed. GRF glue was used in 21 cases (18 proximal and 14 distal anastomosis sites) since 1995 with outer felt reinforcement (GRF group).

There was no operative deaths. In-hospital mortality was 4.8% in the GRF group and 7.1% in the control group (P = 0.7308). Intraoperative blood loss and transfusion requirements were similar between groups. The patency of the distal false lumen after the operation (57% vs. 55%, P = 0.8855), the 3-year survival estimate (82% +/- 10% vs. 92% +/- 6%, P = 0.4219), and the 3-year actuarial freedom from a reoperation of 92 anastomoses (97% +/- 3% vs. 100%, P = 0.4986) were similar between the GRF group and the control group, respectively. A multivariate Cox's proportional hazard model identified no significant predictor for midterm death or reoperation.

The use of GRF glue for type A acute aortic dissection seems as clinically safe as other options with regard to midterm death or reoperation when applied appropriately with felt reinforcement.