Biological glues

Gelatin-resorcinol-formaldehyde blue (GRF): This glue (also known as French Blue) was developed in the 1960s by Cooper and Falb [11] as an alternative to the cyanoacrylates. The mixture of gelatin and resorcinol (3:1) and addition of an 18% formaldehyde solution renders a sealant which cross-links tissues (covalently and avidly) in less than 1 min.

Table 9.3. Linear regression coefficients, where PC represents the independent variable (x), and PPI, PI, PD, and PPD are dependent variables (y)

Series

ai

a2

r

PPI (y)

0.542

0.018

0.996

PI (y)

0.586

0.031

1.000

PD (y)

0.542

0.018

0.999

PPD (y)

0.542

0.018

0.999

r : correlation coefficient.

r : correlation coefficient.

FORMALDEHYDE

RESORCINOL

RESORCINOL

GLUTARALDEHYDE

Figure 9.2. Chemical structure of the components of some BioGlues

BioGlue: Evolved from GRF glue, it is composed of 10% glutaraldehyde and 45% bovine albumin. When these two components are combined, the aldehyde groups of glutaraldehyde form stable imine cross-links with the amino groups of the proteins (Figure 9.2). The polymerization of the adhesive commences immediately and the reaction is completed in less than 2 min.

Both GRF and BioGlue have been used in a variety of soft tissue applications, but technical problems and the cytotoxicity of formaldehyde and glu-taraldehyde have limited their application to acute type A aortic dissection.

The use of and results with these sealants are controversial. Some authors, in a retrospective 20-year analysis, report the use of GRF as extremely useful during initial emergency surgery for acute type A dissection, making the procedure much easier and safer [12]. Others who have reviewed its use report alterations of the aortic wall, unacceptable long-term complications and a high incidence of recurrent aortic regurgitation [4,12,13]. Still others prefer full root replacement to treat dissection of the aortic root [15]. These controversial data should be considered with caution. Success with biomaterials of this type (as with other types of surgical procedures or pharmacological treatments) depends on the experience of the surgical team, the amount of the product applied, and the physical conditions of the tissue, which is to be sealed. In other words, the correct use of the glue and previous training on the part of the surgeon (if inexperienced) in in vivo models prior to employing it in patients are essential aspects.

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