- Email: [email protected]
Inflammatory response after bioglue application
Ann Thorac Surg 2002;73:1020 – 8
CORRESPONDENCE
1025
plexity, increases operating room time, and facilitates early postoperative hospital discharge. Anesthesiology 2000;92: 1637– 45.
Reply To the Editor: We thank the authors for their comments. An appendix to our report that contained the details of the matching process was removed for the sake of brevity during review of the manuscript. Age was matched by 5-year increments, whereas valve type, surgeon type (only those who performed minimally invasive valve operation), history of previous cardiac surgical procedures, and presence of congestive heart failure were exactly matched. The definition of congestive heart failure was New York Heart Association class III or IV. The variables and the data form were those used by the independently audited New York State Cardiac Surgery Reporting System. Length of stay was primarily associated with type of operative procedure. Our earlier prospective, nonrandomized study [1] showed that the minimally invasive approach is associated with reduced postoperative pain, increased speed of recovery, and improved quality of life after discharge. We continue to believe that postoperative pain and its ramifications play a major role in determining the length of stay and perioperative quality of life. Eugene A. Grossi, MD F. Gregory Baumann, PhD New York University Medical Center 530 First Ave, Suite 9V New York, NY 10016 e-mail: [email protected].
Reference 1. Grossi EA, Zakow PK, Ribakove G, et al. Comparison of post-operative pain, stress response, and quality of life in port access vs. standard sternotomy coronary bypass patients. Eur J Cardiothorac Surg 1999;16(Suppl 2):S39 – 42.
Fig 1. Glue remnant surrounded by granulocytes (small arrow), histiocytes (big arrow), and multinucleated giant cells (curved arrow) indicating a severe active inflammation. massive foreign-body reaction with numerous multinucleated giant cells (Fig 1). We mention these findings as a possible variation in the response to this kind of biological glue. Whether this major inflammatory response has any adverse effects over time remains unclear. Nevertheless, the reaction to biological glues such as BioGlue seems to depend on the individual and needs further evaluation. Armin W. Erasmi, MD Hans H. Sievers, MD Department of Cardiac Surgery Medical University of Luebeck Ratzebeurger Allee 160 23538 Luebeck, Germany e-mail: [email protected]. e-mail: [email protected]. Charlotte Wohlschla¨ ger, MD
Inflammatory Response After BioGlue Application To the Editor: We read with interest the article by Hewitt and associates [1] regarding the efficacy and histopathology of the adhesive BioGlue in aortic surgical procedures. They used this adhesive to control bleeding after end-to-side bypass grafting of the abdominal aorta in a sheep model. Histopathologic evaluation showed only “a relative paucity of prominent inflammatory response.” Chronic granulomatous inflammation as a possible foreignbody reaction was seen only rarely, and multinucleated giant cells were not found in any sample. These results were confirmed by histologic study of specimens from 2 patients. We had the opportunity to examine a specimen from a dissecting descending thoracic aortic aneurysm that necessitated replacement of that section of the aorta 3 months after replacement of the ascending aorta and reconstruction of the arch with BioGlue for type A dissection. We found a 10 ⫻ 2 ⫻ 0.5-cm glue remnant in the false lumen of the aneurysm adherent to the dorsal aortic wall. In contrast to the findings of Hewitt and colleagues [1], histologic study of the specimen showed a severe active inflammation surrounding the glue remnant with multiple granulocytes and histiocytes and a © 2002 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
Institute for Pathology Medical University of Luebeck Ratzebeurger Allee 160 23538 Luebeck, Germany
Reference 1. Hewitt CW, Marra SW, Kann BR, et al. BioGlue surgical adhesive for thoracic aortic repair during coagulopathy: efficacy and histopathology. Ann Thorac Surg 2001;71:1609–12.
Reply To the Editor: We thank Drs Erasmi, Sievers and Wohlschla¨ ger for their comments regarding our article on BioGlue surgical adhesive [1]. The histopathologic descriptions in that article generally involved sheep. As we wrote, “Explanted tissues were examined at various times, ranging from 2 hours to 3 months after operation.” It was noted that after 3 months, “BioGlue deposits were composed of a homogeneous, eosinophilic material surrounded by a thin, discontinuous zone of mature, fibrous connective tissue” and that “chronic granulomatous inflammation 0003-4975/02/$22.00
CORRESPONDENCE
1025
plexity, increases operating room time, and facilitates early postoperative hospital discharge. Anesthesiology 2000;92: 1637– 45.
Reply To the Editor: We thank the authors for their comments. An appendix to our report that contained the details of the matching process was removed for the sake of brevity during review of the manuscript. Age was matched by 5-year increments, whereas valve type, surgeon type (only those who performed minimally invasive valve operation), history of previous cardiac surgical procedures, and presence of congestive heart failure were exactly matched. The definition of congestive heart failure was New York Heart Association class III or IV. The variables and the data form were those used by the independently audited New York State Cardiac Surgery Reporting System. Length of stay was primarily associated with type of operative procedure. Our earlier prospective, nonrandomized study [1] showed that the minimally invasive approach is associated with reduced postoperative pain, increased speed of recovery, and improved quality of life after discharge. We continue to believe that postoperative pain and its ramifications play a major role in determining the length of stay and perioperative quality of life. Eugene A. Grossi, MD F. Gregory Baumann, PhD New York University Medical Center 530 First Ave, Suite 9V New York, NY 10016 e-mail: [email protected].
Reference 1. Grossi EA, Zakow PK, Ribakove G, et al. Comparison of post-operative pain, stress response, and quality of life in port access vs. standard sternotomy coronary bypass patients. Eur J Cardiothorac Surg 1999;16(Suppl 2):S39 – 42.
Fig 1. Glue remnant surrounded by granulocytes (small arrow), histiocytes (big arrow), and multinucleated giant cells (curved arrow) indicating a severe active inflammation. massive foreign-body reaction with numerous multinucleated giant cells (Fig 1). We mention these findings as a possible variation in the response to this kind of biological glue. Whether this major inflammatory response has any adverse effects over time remains unclear. Nevertheless, the reaction to biological glues such as BioGlue seems to depend on the individual and needs further evaluation. Armin W. Erasmi, MD Hans H. Sievers, MD Department of Cardiac Surgery Medical University of Luebeck Ratzebeurger Allee 160 23538 Luebeck, Germany e-mail: [email protected]. e-mail: [email protected]. Charlotte Wohlschla¨ ger, MD
Inflammatory Response After BioGlue Application To the Editor: We read with interest the article by Hewitt and associates [1] regarding the efficacy and histopathology of the adhesive BioGlue in aortic surgical procedures. They used this adhesive to control bleeding after end-to-side bypass grafting of the abdominal aorta in a sheep model. Histopathologic evaluation showed only “a relative paucity of prominent inflammatory response.” Chronic granulomatous inflammation as a possible foreignbody reaction was seen only rarely, and multinucleated giant cells were not found in any sample. These results were confirmed by histologic study of specimens from 2 patients. We had the opportunity to examine a specimen from a dissecting descending thoracic aortic aneurysm that necessitated replacement of that section of the aorta 3 months after replacement of the ascending aorta and reconstruction of the arch with BioGlue for type A dissection. We found a 10 ⫻ 2 ⫻ 0.5-cm glue remnant in the false lumen of the aneurysm adherent to the dorsal aortic wall. In contrast to the findings of Hewitt and colleagues [1], histologic study of the specimen showed a severe active inflammation surrounding the glue remnant with multiple granulocytes and histiocytes and a © 2002 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
Institute for Pathology Medical University of Luebeck Ratzebeurger Allee 160 23538 Luebeck, Germany
Reference 1. Hewitt CW, Marra SW, Kann BR, et al. BioGlue surgical adhesive for thoracic aortic repair during coagulopathy: efficacy and histopathology. Ann Thorac Surg 2001;71:1609–12.
Reply To the Editor: We thank Drs Erasmi, Sievers and Wohlschla¨ ger for their comments regarding our article on BioGlue surgical adhesive [1]. The histopathologic descriptions in that article generally involved sheep. As we wrote, “Explanted tissues were examined at various times, ranging from 2 hours to 3 months after operation.” It was noted that after 3 months, “BioGlue deposits were composed of a homogeneous, eosinophilic material surrounded by a thin, discontinuous zone of mature, fibrous connective tissue” and that “chronic granulomatous inflammation 0003-4975/02/$22.00