[HSF] Bioglue - Cyanoacrylate

[Nasser F. Abou'Seada]

Prasanna 
I'm very much interested in your use of Cyanoacrylate ... Super glue ...
would you elaborate on how you use it, exact technique, sterilization "of
containing tube" ... precautions ... noted adverse effects ... how many
cases ... types of cases ???? .... any studies on that ??? histology ? 
How would you insert your experience of Cyanoacrylate in Ben's
classification ??? 

NFA
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Monday, November 06, 2006 1:35 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Bioglue
> 
> Giulio,
>  I have used cyanoacrylate glue (basically super glue ) extensively. The
> one thing that is important is to have a dry field. This may involve
> clamping or even a short period of circ arrest. If the area is not dry
> and blood free then the blood congeals on the glue  instead of two ends
> sticking.
> I t works well to sterilize meshes and also for postoperative sinuses
> too. I have even glued percutaneously unstable sternums with and without
> fibrous union. It  works well in them too.
> Prasanna
> Giulio Rizzoli wrote:
> >
> > Thank You Ben for the nice summarization.
> > I will add that among the adhesives there are the acrylic glues. Their
> > use was proposed in this  forum as a lifesaving maneuver in cases of
> > bleedings located in not reachable areas.
> > I experienced one of these cases in an aortic root replacement that
> > was successfully solved, as proposed by Levinson (I think) on this
> > forum by clamping both caval veins followed by clamping of the aortic
> > prosthesis and applying the acrylic glue on the blood deprived field.
> > The advantage of the glue in this case was in the rapidity of action
> > so the heart tolerated without problem the maneuver.
> > I don't use the commercially available acrylic glue but a modification
> > of it commercialized with the name "Glubran" (you can search it in the
> > internet).
> > The advantage is that doesn't prohibit the stitching with needles
> > because doesn't produce a very hard surface. If You use it on a dry
> > suture line you can be sure that you will not loose a single drop of
> > blood from that suture line.
> >
> > Giulio Rizzoli
> >
> >
> >
> >
> > One needs to look at such things as glues or adhesives and hemostatic
> > agents.
> >
> > GRF and BioGlue are adhesives. They form a firm layer that allows 2
> > surfaces to adhere - ie layers of a dissection. The 'curing' that
> > happens with the glutaraldehyde or formalin cures the other components
> > which glue the surfaces together. They are hemostatic in that they
> > provide a firm layer, not that they encourage hemostasis (rather they
> > probably discourage it with their toxic nature).
> > We have then the biological sealants. These are the various fibrin
> > glues Tisseel for one. These rely on naturally occurring fibrinogen
> > being converted to fibrin in an area of bleeding. If you can keep the
> > layer from floating away it can help. They are naturally absorbed.
> > There are the substances that provide a substrate for clotting  e.g.
> > Surgicel (oxidised cellulose). Topical thrombin is often used with this.
> > There are a series of similar products such as Tachosil, Tachocomb
> > etc. These are not so much as adhesives but sealants.
> > There are now a wealth of other synthetic substances. These include
> > Hemaderm or Medafor (a starch based compound that absorbs blood and
> > promotes clotting as well as providing a degree of tamponade). CoSeal
> > and related substances act as sealants with no mechanical strength.
> >
> > There are also the devices Tomas mentioned a couple of weeks ago.
> >
> > These all are topical. I have not mentioned any of the drugs that can
> > be given internally (lysine analogues and aprotinin etc.)
> >
> > So, as far as Bioglue goes, not good for stopping bleeding, but useful
> > in VSD and LV rupture etc.
> > It has a drawback - it solidifies and thus can embolise.
> >
> > So, there are horses for courses.
> > (Sorry for the lecture it is part of a talk on such things)
> 
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