[HSF] Bioglue - Cyanoacrylate

Nasser F. Abou'Seada nfaabouseada at gmail.com
Tue Nov 7 05:42:07 EST 2006 

THANK YOU DON 
That was very helpful indeed 

NFA
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of Ben Bidstrup
> Sent: Monday, November 06, 2006 6:10 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: RE: [HSF] Bioglue - Cyanoacrylate
> 
> Sorry, I had left that out. It is another
> adhesive. Because of its very rapid setting in a
> dry environment it can be used for haemostasis of
> small holes. Be warned, it also is very toxic and
> can get into places you don't want it to.
> The glue itself is sterile. Nothing could live in
> that. Just soak the tube in gluteraldehyde or
> something like that. You can buy the medical
> version from Ethicon  as Dermabond.
> Good for sticking small things together, like
> skin, eyelids etc. Plenty of data on it from
> here:
> http://www.jnjgateway.com/home.jhtml?loc=USENG&page=viewContent&contentId=
> 09008b98807758f2&parentId=09008b98807758f2.
> 
> So if you have a piece of aorta that is loose
> after say after an AVR or small area of
> dissection, it can be applied before the clamp is
> removed. Look at Ethicon's web site under wound
> care for many other 'haemostatic substances.'
> Collagen fleece etc.
> 
> >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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> 
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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