Ecomment: Biological Glue: a Word of Careful Assessment!

piglet aorta [2]. Such findings were absent in control animals. Similarly, severe active inflammation surrounding BioGlue and a foreign body reaction at three months following application has been demonstrated by Erasmi et al. [3]. BioGlue is relatively more fluid than gelatin-resorcinformalin (GRF) glue. In the supine patient who is undergoing aortic dissection repair, the left coronary ostium lies in a dependant position. Upon application of BioGlue between the dissected layers of the aortic root, the liquid glue would track under the influence of gravity towards the left coronary ostium. Over and above the aortic dissection, the glue serves as an additional nidus for tissue inflammation and hence more fibrosis. The fibrosis around the aortic root and the left coronary ostium is well demonstrated by increased tissue attenuation on CT-scan. In our patient, this eventually resulted in severe ostial coronary stenosis and unstable angina three months after the dissection repair. Although BioGlue is an effective haemostat, it is of paramount importance that surgeons are aware of its potential dangers. In order to avoid this complication, we suggest that the aortic root should be reinforced with Teflon (PTFE) strips alone or that glue should be used sparingly and with extreme caution.