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Nerve and Conduction Tissue Injury Caused by Contact with BioGlue

2007; Elsevier BV; Volume: 143; Issue: 2 Linguagem: Inglês

10.1016/j.jss.2006.10.014

1095-8673

Scott A. LeMaire, Lyssa Ochoa, Lori D. Conklin, Zachary C. Schmittling, Akif Ündar, Fred J. Clubb, Xing Li Wang, Joseph S. Coselli, Charles D. Fraser,

Surgical Sutures and Adhesives

Background BioGlue—a surgical adhesive composed of bovine albumin and glutaraldehyde—is commonly used in cardiovascular operations. The objectives of this study were to determine whether BioGlue injures nerves and cardiac conduction tissues, and whether a water-soluble gel barrier protects against such injury. Materials and methods In 18 pigs, diaphragmatic excursion during direct phrenic nerve stimulation was measured at baseline and at 3 and 30 min after nerve exposure to albumin ( n = 3), glutaraldehyde ( n = 3), BioGlue ( n = 6), or water-soluble gel followed by BioGlue ( n = 6). Additionally, BioGlue was applied to the cavoatrial junction overlying the sinoatrial node (SAN), either alone ( n = 12) or after application of gel ( n = 6). Results Mean diaphragmatic excursions in the BioGlue and glutaraldehyde groups were lower at 3 min and 30 min than in the albumin group ( P < 0.05). Mean excursions in the gel group were similar to those of the albumin group ( P = 0.9). Five BioGlue pigs (83%) and one gel pig (17%) had diaphragmatic paralysis by 30 min ( P < 0.05 and P = 0.3 versus albumin, respectively). Coagulation necrosis extended into the myocardium at the cavoatrial junction in all 12 BioGlue pigs but only two gel pigs (33%, P < 0.01). Two BioGlue pigs (17%), but no gel pigs, had focal SAN degeneration and persistent bradycardia ( P < 0.01). Conclusions BioGlue causes acute nerve injury and myocardial necrosis that can lead to SAN damage. A water-soluble gel barrier is protective.