Gelatin-resorcinol-formaldehyde Research Articles

Intimal-protected adventitial inversion technique accelerates the obliteration of a patent false lumen.

The optimal procedure for reconstructing the dissected aortic stump for acute type A dissection remains controversial. We routinely used the intimal-protected adventitial inversion technique (iPAIT), a modified adventitial inversion technique, to protect the fragile intima by inserting a graft and assessed the safety and efficacy of this technique. Between August 2008 and April 2020, 146 consecutive patients with acute type A dissections underwent thoracic aortic surgery in our hospital. Extended total aortic arch replacement was performed in 119 patients (81.5%). Sixty-nine patients underwent treatment for distal aortic anastomosis with the iPAIT. To compare the iPAIT to a historical control, we assessed 69 iPAIT patients and 25 patients who underwent total arch replacement using gelatin-resorcinol-formaldehyde (GRF) glue. Hospital mortality was 2.9% in the iPAIT group and 8.0% in the GRF group. Perioperative characteristics were similar between the two groups. However, postoperative computed tomographyrevealed that the obliteration rate was significantly higher in the iPAIT group (60/66, 90.9%) than in the GRF group (15/23, 65.2%) (p = .01), not including the patients who had died or developed severe renal dysfunction. The 8-year aortic event-free survival rate in the iPAIT group (81.3%) was significantly higher than that in the GRF group (47.4%). The use of this technique for acute type A dissections resulted in a low mortality rate and demonstrated promising midterm survival and may accelerate the obliteration of a patent false lumen and prevent late aortic events.

Inferior ischemic ventricular septal defect: Atypical triple pericardial patch implantation technique

We presented the successful management of an inferior ischemic ventricular septal defect (VSD) associated with posterior left ventricular free wall rupture, following the occlusion of a dominant right coronary artery (RCA). The defect was approached through a longitudinal incision over the infarcted area, 1 cm parallel to the posterior descending coronary artery (PDA). The VSD was repaired using three pericardial patches and GRF (gelatin-resorcinol-formaldehyde) glue. ECMO and IABP were used in order to decrease the LV wall tension, the risk of recurrence of VSD and the risk of free wall rupture. The postoperative echocardiogram documented good biventricular geometry with a left ventricle ejection fraction (LVEF) of 55%. No left-to-right shunt was seen

Clinical, mechanical, and immunohistopathological effects of tissue adhesives on the colon: An in‐vivo study

Tissue adhesives may be useful for sealing bowel anastomoses by preventing anastomotic leakage. Prior to clinical implementation, an in-depth analysis of the clinical and immunohistopathological effects of tissue adhesives on the target tissue and of the mechanical strength of the adhesive bond in an in vivo model is needed. In 84 rats, two bowel segments were glued using one of the following tissue adhesive: Bioglue, Gelatin-resorcinol-formaldehyde (GRF), Glubran 2, Histoacryl Flex, Omnex, Duraseal Xact, or Tissucol. Rats were followed for 7 or 28 days. Endpoints were clinical complication rate, mechanical strength, and immunohistopathological reactions. Of the seven tissue adhesives, GRF and Bioglue showed the highest rates of bowel wall destruction and ileus and the most severe immunohistopathological tissue reactions at 7 and 28 days. Cyanoacrylates (Histoacryl Flex, Omnex, Glubran 2) showed high mechanical strength and mild immunohistopathological reactions at 7 and 28 days. Duraseal Xact and Tissucol were the most inert tissue adhesives, but exhibited low mechanical strength. At 28 days, mechanical strength was significantly correlated to CD8, CD68, and Ki67 cell counts. Based on the clinical and immunohistopathological outcomes, GRF and Bioglue were found to be the least suitable tissue adhesives for colonic use. Duraseal Xact and Tissucol were inert but also showed low mechanical strength. Cyanoacrylates exhibited mild clinical and immunohistopathological effects while maintaining high strength, which makes them promising as colonic sealants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 846-854, 2017.

Reoperation After Surgical Correction of Acute Type A Aortic Dissection: Risk Factor Analysis

Aortic dissection is an evolving process that may require one or several reoperations after its initial repair. We conducted a study to evaluate risk factors and define the incidence and locations of reoperations after surgical correction of acute type A aortic dissection (AAD). Between 1998 and 2008, 250 consecutive patients (mean age 62.5±12.4 years) underwent surgery for AAD at our institution. Replacement of the ascending aorta was done in 173 cases, composite graft replacement in 61 cases, separate aortic valve and ascending aorta replacement in 2 cases, and arch replacement required by distal repair in 14 cases. Mean follow-up time was 4.7±5.6 years. Freedom from reoperation was 99%, 82%, and 79% at 1, 5, and 10 years, respectively. Twenty-five patients required 25 reoperations at a mean interval of 4.7 years after initial surgery for the correction of AAD. Reoperations included 21 procedures on the proximal aorta (ascending aorta, aortic root, or valve) and 4 procedures on the distal aorta (arch or descending aorta). Cox regression analysis identified the use of gelatin-resorcinol-formaldehyde (GRF) glue (p=0.0270), and nonreplacement of the aortic root at the time of initial AAD repair (p=0.0004), as a significant risk factor for proximal reoperation, and a patent false lumen (p=0.0107) as a significant risk factor for distal reoperation. A patent false lumen, the use of GRF glue, and aortic root preservation at initial operation influence the risk for surgical correction in patients undergoing surgery for AAD. These patients need long-term follow-up.

Physical and biological properties of a novel siloxane adhesive for soft tissue applications

The aim of this study was to investigate the adhesive properties of an in-house amino-propyltrimethoxysilane-methylenebisacrylamide (APTMS-MBA) siloxane system and compare them with a commercially available adhesive, n-butyl cyanoacrylate (nBCA). The ability of the material to perform as a soft tissue adhesive was established by measuring the physical (bond strength, curing time) and biological (cytotoxicity) properties of the adhesives on cartilage. Complementary physical techniques, X-ray photoelectron spectroscopy, Raman and infrared imaging, enabled the mode of action of the adhesive to the cartilage surface to be determined. Adhesion strength to cartilage was measured using a simple butt joint test after storage in phosphate-buffered saline solution at 37°C for periods up to 1 month. The adhesives were also characterised using two in vitro biological techniques. A live/dead stain assay enabled a measure of the viability of chondrocytes attached to the two adhesives to be made. A water-soluble tetrazolium assay was carried out using two different cell types, human dermal fibroblasts and ovine meniscal chondrocytes, in order to measure material cytotoxicity as a function of both supernatant concentration and time. IR imaging of the surface of cartilage treated with APTMS-MBA siloxane adhesive indicated that the adhesive penetrated the tissue surface marginally compared to nBCA which showed a greater depth of penetration. The curing time and adhesion strength values for APTMS-MBA siloxane and nBCA adhesives were measured to be 60 s/0.23 MPa and 38 min/0.62 MPa, respectively. These materials were found to be significantly stronger than either commercially available fibrin (0.02 MPa) or gelatin resorcinol formaldehyde (GRF) adhesives (0.1 MPa) (P < 0.01). Cell culture experiments revealed that APTMS-MBA siloxane adhesive induced 2% cell death compared to 95% for the nBCA adhesive, which extended to a depth of approximately 100–150 μm into the cartilage surface. The WST-1 assay demonstrated that APTMS-MBA siloxane was significantly less cytotoxic than nBCA adhesive as an undiluted conditioned supernatant (P < 0.001). These results suggest that the APTMS-MBA siloxane may be a useful adhesive for medical applications.

Repair of Delayed Left Ventricular Rupture After Mitral Valve Replacement: Report of a Case

Rupture of the left ventricle (LV) after mitral valve replacement (MVR) is a devastating complication, associated with high mortality. A 64-year-old woman with a type I delayed LV rupture, which occurred after MVR with a 27-mm St. Jude Medical mitral prosthesis for mitral stenosis, was successfully treated by a combination of intracardiac and extracardiac surgical repair techniques. The extracardiac repair involved approximating the edges of myocardium around the tear with large sutures bolstered by strips of Teflon felt, then covering the epicardial hematoma with another porcine pericardial patch, using gelatin resorcinol formaldehyde glue and collagen sheets. The intracardiac repair involved suturing the edges of an oval piece of porcine pericardium to the endocardium around the laceration. No LV pseudoaneurysm was detected postoperatively on echocardiography or computed tomography scans. The patient is well 2 years after the operation.

Pathologic findings of aortic redissection after glue repair of proximal aorta

Gelatin-resorcinol-formaldehyde (GRF) glue (Cardial, Technopole, Sainte-Etienne, France) has become the standard choice in the repair of type A dissections.1 Several authors have reported the incidence of redissection of the aortic wall just proximal to the anastomosis. The causes remain controversial and some investigators reported that redissection might be caused by necrosis of the aortic wall caused by GRF glue.2-4 We present our clinical experience with redissection of the aortic root late after repair of type A aortic dissection.

Comparison of the Topical Haemostatic Agents for the Prevention of Suture Hole Bleeding. An Experimental Study

Objective: using a rabbit vascular graft model we investigated the use of fibrin glue (FG), gelatin-resorcinol-formaldehyde (GRF), and collagen (C) as a means of reducing suture hole bleeding.Materials and methods: twenty-eight rabbits were divided into four groups: fibrin glue, gelatin-resorcinol-formaldehyde, collagen and control. A 1cm incision was made in the abdominal aortic wall of each animal. Incisions were covered with a polytetrafluoroethylene patch sutured with a 7-0 polypropylene. Fibrin Glue, GRF, and C were applied to cover suture holes in the groups 1, 2 and 3, respectively, but nothing in controls (group 4). The fibrin clot was allowed to achieve strength for 3 minutes before the clamps were reopened. After reopening the clamps, blood was collected from the surgical site using a syringe for a total of 2min.Results: mean blood loss was significantly lower in the FG, GRF, and C compared with control group (p=0.0022, p=0.0022, and p=0.0017, respectively). The volume of blood lost and the time of haemostasis in the group 1 (FG) was less than those in groups 2 and 3 (GRF and C, respectively) (p=0.001). The haemostasis (defined 2min later) was achieved only in group 1 (FG) (p=0.00067).Conclusions: FG, GRF and C all reduce blood loss. Fibrin glue containing factor XIII was the most effective.

Glue aortoplasty repair of aortic dissection after coronary angioplasty

Aortic dissection complicating percutaneous transluminal coronary angioplasty is rare. We report the case of a 45-year-old man who after right coronary artery angioplasty with stenting, dissected that vessel to involve the aorta to the bifurcation. Surgical repair with Gelatin-Resorcinol-Formaldehyde (GRF) glue as opposed to prosthetic graft replacement of the ascending aorta was successful. The use of GRF glue is effective in the surgical treatment of aortic dissection after coronary angioplasty.

Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root

Background. Redissection of the aortic root after supracommissural aortic graft replacement with reapproximation of the layers of the dissected aortic root is relatively rare. Causes and surgical treatment of this lesion remain controversial. Methods. From January 1983 to September 2000, 130 patients had emergency operation for acute type A aortic dissection. Of them, 57 patients underwent root reconstruction using biologic glues and 4 patients (7.0%) developed redissection of the aortic root associated with moderate to severe aortic regurgitation 5 to 27 months after the initial operation. In all patients, the proximal false lumen was obliterated with infusion of gelatin-resorcinol-formaldehyde (GRF) glue or BioGlue and the aorta was reinforced with Teflon felt strip or Surgicel placed on its outside wall. Results. During reoperation, the noncoronary aortic sinus was found to be redissected in all patients with the dissection extending retrogradely to the aortic annulus. This resulted in aortic regurgitation with prolapse of the noncoronary cusp because the proximal suture line dehisced. Histopathology showed disappearance of the nuclei of the medial smooth muscle cells, suggesting tissue necrosis at the site of GRF glue application. The lesions were treated successfully with full root replacement using a freestyle heterograft bioprosthesis or a composite graft prosthesis. Conclusions. The use of biologic glues for reapproximating the layers of the dissected aortic root is associated with a certain amount of risk of aortic wall necrosis. Therefore, care should be taken to ensure proper use of these glues. Full root replacement could be a preferable technique for treating redissection of the aortic root.

Late complications of tissue glues in aortic surgery

Background. Tissue glues are used in cardiothoracic surgery as an adjunct to operative procedures where tissues are frail, as in aortic dissection, or where added hemostasis is required. This study was undertaken to review the use of tissue glue in our institution over a 5.5-year period. The aim of the study was to identify any potentially glue-related complications. Methods. A review of tissue glue use for the period from January 1993 to September 1998 was performed and pre-, intra-, and postoperative parameters were collected. After some unusual surgical findings, of special interest was a range of pathology found at late reoperation. Results. A total of 67 cases of tissue glue use were identified, with the majority of operations for type A dissection (76%). There were two intraoperative deaths. Twenty-seven of 65 patients (41%) required 29 further open chest operations; of these, 17 were for acute problems of bleeding or tamponade. Twelve patients (18%) underwent late reoperations months to years later. Nine of these patients, concentrated in two operative groups (7 patients with aortic valve resuspension and 2 patients who had undergone “switch” operations for transposition of great vessels), displayed complications related to the application of gelatin-resorcinol-formaldehyde (GRF) tissue glue. Conclusions. Indications for tissue glues in cardiothoracic surgery must be carefully considered. We have reviewed our use of some tissue glues in acute type A aortic dissections and in pediatric cardiac patients and have discontinued the use of GRF glues because of unsatisfactory long-term complications.

THE USE OF BIOLOGICAL GLUE IN AORTIC SURGERY

The biologic sealants presently available on the market that are used in cardiovascular surgery and particularly during surgery of the aorta are described in this article. Two of these biological sealants, the gelatin-resorcinol-formaldehyde (GRF) glue and two-component fibrin sealant have been in use for two decades. Their respective properties are described beneficial in modifying the natural history of the disease. Certain pharmacological agents that result in improved aortic function have been identified.

Gelatin-derived bioadhesives for closing skin wounds: An in vivo study

Bioadhesives have been used in surgery as hemostatic and wound healing agents. GRF (gelatin + resorcinol + formaldehyde) glue, composed of a mixture of gelatin and resorcinol polymerized by the addition of formaldehyde, has been used for this purpose. Widespread acceptance of the GRF glue, however, has been limited by reports of cytotoxicity due to its release of formaldehyde upon degradation. It has been suggested by Wertzel et al. that the cytotoxicity problem of GRF glue may be overcome by changing its cross-linking method. The study was, therefore, undertaken to assess the feasibility of using a water-soluble carbodiimide or genipin to cross-link gelatin as new bioadhesives to close skin wound lesions in a rat model. Formaldehyde-cross-linked counterpart (GRF glue) and a resorbable suture were used as controls. It was noted that the tensile strength of the skin across each wound treated by either application of test glues or suture increased consistently with time during the healing process. Also, the wounds repaired by test glues or suture caused no calcification. The suture used in the study was completely resorbed at the wound area in about 6 days postoperatively. However, the durations required to completely resorb the carbodiimide-or genipin-cross-linked glues were approximately the same (9 days), while it took about 14 days to completely resorb the formaldehyde-cross-linked glue. The healing process for the suture wound repaired was more rapid than those treated by test glues. Of the test glues, the wounds treated by the carbodiimide- or genipin-cross-linked glues induced less inflammatory response and recovered sooner than that treated by the formaldehyde-cross-linked glue. This indicated that the biocompatibility of the carbodiimide- or genipin-cross-linked glues was superior to the formaldehyde-cross-linked glue. The results of this study may serve as a preliminary experimental model for the further investigation of both the carbodiimide- and genipin-cross-linked glues when applied to human skin closure.

SYMPTOMATIC CALICEAL DIVERTICULA TREATED WITH EXTRAPERITONEAL LAPAROSCOPIC MARSUPIALIZATION FULGURATION AND GELATIN RESORCINOL FORMALDEHYDE GLUE OBLITERATION

Purpose The treatment of symptomatic stone filled caliceal diverticula has evolved from open surgery to less invasive procedures, such as extracorporeal shock wave lithotripsy, percutaneous techniques, retrograde ureteroscopy and laparoscopy, but it remains controversial. We describe a laparoscopic technique for the management of symptomatic caliceal diverticula. Materials and Methods An extraperitoneal laparoscopic procedure was done in 3 women with symptomatic caliceal diverticula. Watertight obliteration of the diverticular cavity was achieved without suturing, using gelatin resorcinol formaldehyde glue. Results Average operating time was 80 minutes, including ureteral catheterization. All patients became stone-free, there were no complications and average hospital stay was 6.6 days. At 6-month followup the patients remained asymptomatic with no diverticula or stone recurrence. Conclusions Retroperitoneoscopy allows safe access to caliceal diverticula regardless of location, and permits complete removal of stone and fulguration of the diverticular neck. Gelatin resorcinol formaldehyde glue minimizes the risk of urinoma formation, and provides a simple, quick and safe alternative for nephrotomy closure.

Feasibility Study on the Use of a Tissue Adhesive for the Nonsurgical Blocking of Fallopian Tubes. Phase I: Evaluation of a Tissue Adhesive

This report discusses a short feasible method to determine if a tissue adhesive could be used to immediately block fallopian tubes and promote tissue ingrowth with permanent occlusion of the tubes. An adhesive was developed based on a gelatin-resorcinol-formaldehyde (GRF) formulation which was nontoxic biodegradable and acceptable to ingrowth of surrounding tissue. It was known to function in mucosal areas. For the study New Zealand white female rabbits were used. Through an abdominal incision the uterus was brought into view an 18-gauge Teflon catheter inserted and threaded through the uterine horn to the utero-tubal junction and the GRF injected. To prevent backflow of the adhesive into the uterine horn and to force the liquid into the tube a temporary ligature of umbilical tape was placed around the uterine horn and the catheter. This ligature was removed when the injection was completed. The GRF adhesive consisted of 2 parts: 1) 45 parts gelatin 15 parts resorcinol and 40 parts water; 2) 38% formaldehyde solution to make up 10% of the total. The 2 components are mixed immediately prior to injection. Dilution up to 10% with a .1N hydrochloric acid solution and heating to 40-50 degrees C. may be needed. Solidification time is thus increased by 5 minutes. The formaldehyde causes the gelatin-resorcinol mixture to solidify and also acts to promote adhesion between the glue and the tissue. Animals were sacrificed at intervals from 4 to 27 days. Blockage was shown in the treated tubes. Early histologic studies showed necrosis of the epithelial layer. Later invasion of cells into the GRF plug was seen. There was good attachment of the plug to the mucosal layer. By this method permanent tubal occlusion with the ingrowth of tissue is believed to be possible.