BioGlue in 2011: what is its role in cardiac surgery?

Abstract

BioGlue surgical adhesive was developed as an adjunct for achieving hemostasis during cardiovascular surgery, and it was approved for use in the United States by the Food and Drug Administration in 2001. When applied to cardiovascular tissues, the glutaraldehyde and bovine serum albumin that comprise BioGlue produce strong crosslinking that bonds tissues and seals defects. These features have made BioGlue particularly well suited for preventing bleeding from fragile cardiovascular anastomoses such as those inherent in the repair of acute aortic dissection. Over the 10-year period since its approval, several studies and clinical reports have illuminated the relative risks and benefits of using BioGlue during cardiovascular operations. Understanding these merits and limitations of BioGlue is essential to ensuring its safe and effective use.

Conflict of interest statement

Scott A. LeMaire has stated that he is a member of the advisory board at Baxter Healthcare.

Figures

Figure 1.

Illustrations showing the use of BioGlue during repair of an acute proximal aortic dissection. (A) After the dissecting membrane is tacked to the outer aortic wall with a few interrupted sutures, a 30-mL balloon-tipped catheter is inflated in the true lumen of the proximal descending thoracic aorta; the balloon prevents distal migration of the adhesive. A moist sponge can be inserted into the true lumen to protect the origins of the brachiocephalic branches. BioGlue is applied within the false lumen to bond the torn layers back together. After the distal anastomosis is completed, a thin layer of BioGlue is applied to the suture line. (B) A similar technique is used to repair the aortic root. A moist sponge is used to protect the coronary ostia and the aortic valve leaflets. To prevent BioGlue from leaking into the left ventricle, it is important to keep the sump suction turned off while the adhesive is being applied to the ascending aorta and aortic root. Images adapted from Creager MA, Dzau VS, Loscalzo J, eds.: Vascular Medicine. Philadelphia, PA: WB Saunders; 2006. Copyright © Saunders/Elsevier, 2006, Figures 35–3C and 35–3F.