Fibrin glue in cardiothoracic surgery.

Abstract

FOR YEARS, surgeons have been searching for the perfect to help decrease bleeding, seal anastomoses, and bond tissue. Initial results with a plastic glue, cyanoacrylate, were encouraging, but clinical use was generally abandoned because the glue caused intense inflammatory reactions. I-S The first biological glue was developed by Matras,9 who built on experience with concentrated fibrinogen preparations and incorporated technical improvements for isolating and concentrating clotting factors. This fibrin glue generated considerable clinical experimentation in a variety of applications, which in tum resulted in hundreds of published articles from around the world. Most of the world has access to commercialIy available standardized products. In the United States altemative methods for fibrin glue preparation were developed IS because the commercially available fibrin glue (Tisseel, Immuno AG, Vienna, Austria; and Beripiast, Behringwerke AG, Marburg, Lahn, Germany) are derived from pooled human fibrinogen, which was banned by the Food and Drug Administration in 1978. 19.20 Therefore, a variety of different types of fibrin glue were prepared using components available through the blood bank (eg, cryoprecipitate, fresh frozen plasma) or special techniques for glue preparation with the assistance of blood banks (eg, autologous glue, single-donor plasma). Fibrin glue has become a generic term for several diverse products, including fibrin seal, biological glue, fibrin gel, and fibrin adhesive. This article reviews the properties of fibrin glue, the sources of glue components, and the clinical applications of the glue in cardiothoracic surgery.