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10. Aortic root necrosis following surgical treatment for acute type A aortic dissection using Gelatin-Resotcin Formalin(GRF) glue.
Shinichi Suzuki, Kiyotaka Imoto, Keiji Uchida, Motohiko Gouda, Toshiki Hatsune, Yoshinori Takanashi; Yokohama, Japan

Objective: Although GRF glue is used in surgery for type A acute aortic dissection (AAD), late complications possibly due to toxicity of the GRF glue have been reported. We evaluated the benefit and risk of using GRF glue to surgery of AAD.
Methods: Between January 1990 and August 2003, 269 patients(153 male, 116 female, with meanage of ±; range: to years old) had emergency operations for type A AAD. GRF glue was not used in 47 patients ( group non-GRF) who received operation before 1996, and used in 222 ( group GRF). In group GRF, the proximal false lumen was obliterated with infusion of GRF glue and we didn’t use any felt strips at this proximal anastomosis.
Results: The hospital mortality was 31.9% (15 of 47) in group non-GRF, and 12.6% (28/222) in group GRF (p<0.0001). There were 32 patients in group non-GRF, and 194 patients in group GRF, who survived and were followed as outpatients. In group GRF, false aneurysms were found in 31(16%) at 1-65(mean30) months after the initial surgery. In 8 of them, shock was initial symptom of false aneurysms. We have performed reoperations in 24 of them. During reoperations, the site of the GRF glue use was degenerated, and the anastomosis between the aortic root and prosthesis had widely opened that made false aneurysm and resulted in aortic regurgitaions with prolapse of coronary cusp. We performed aneurysmectomy and reanastomosis in 15, with aortic valve replacement in 3, and full root replacemet using composite prosthesis in 6. The mortality of the reoperation was 4.2% ( 1 of 24).
Conclusions: Using GRF glue could improved the shot-term outcome of surgery for type A AAD, but a high incidence of false aneurysm at the proximal site of anastomosis, where GRF glue had been used, was found. These patients should be carefully followed after surgery. We have discontinued the use of GRF glues.

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