# The Impact of Proximal Turn-Up Anastomosis Without Adhesive Repair Using BioGlue for Acute Type A Aortic Dissection

## TL;DR

This study compares the use of BioGlue with and without a turn-up anastomosis in treating acute type A aortic dissection, finding similar outcomes but higher mortality with BioGlue.

## Contribution

The study demonstrates that a turn-up anastomosis without BioGlue is non-inferior and potentially safer for ATAAD surgery.

## Key findings

- In-hospital mortality was 0% in the BioGlue-free group versus 14% in the BioGlue group.
- No significant differences in operation time or bleeding were observed between the two groups.
- Postoperative CT scans showed no difference in thrombosis of the sinus of Valsalva.

## Abstract

Introduction

The prognosis for surgery on acute type A aortic dissection (ATAAD) is poor because the dissected vessel is fragile and prone to bleeding. We have applied a turn-up anastomosis, in which both the Dacron graft and native aortic wall are everted for secure anastomosis. BioGlue (CryoLife, Inc., Kennesaw, GA, USA) has also been occasionally used as an adjunct. However, several potential complications associated with the use of BioGlue have already been reported. This study aimed to compare the clinical impact of BioGlue in patients undergoing ATAAD surgery using proximal turn-up anastomosis.

Materials and methods

Between November 2020 and March 2024, 78 cases were included for ATAAD. The proximal anastomosis was performed with a turn-up anastomosis in all cases, and BioGlue was used as an adjunct in 49 cases (BG). The cases without BioGlue (NBG: 29) and BG were compared.

Results

There were no differences in age, gender, preoperative shock, cardiac tamponade or malperfusion between the two groups. The replacement of ascending aorta was more common in NBG (52%, p=0.0004), while the frozen elephant trunk technique was more common in BG (59%, p=0.0004). Operation time was similar (NBG: 302 min, BG: 277 min, p=0.1451), and no significant difference in intraoperative bleeding (NBG: 1487 mL, BG: 1370 mL, p=0.6942). Both groups had no cases requiring re-anastomosis or repair under re-aortic cross-clamp. In-hospital mortality was 0% in NBG and 14% in BG (The risk difference: 0.142857 (0.044879-0.240835), p=0.0419). Re-exploration for bleeding was similar (NBG: 10%, BG: 6.1%, OR=0.565 [0.106-3.00], p=0.6651). These results were similar for the replacement of ascending aorta only. Postoperative CT scans showed no difference in complete thrombosis of the sinus of Valsalva (p=0.7019). The mean follow-up was 20 months, with one case of aortic root enlargement in BG.

Conclusions

Proximal turn-up anastomosis without BioGlue was shown to be non-inferior to that using BioGlue. Proximal turn-up anastomosis without BioGlue is considered an acceptable technique. The issue of potential late complications remains, and the use of BioGlue should be approached with caution, with its application appropriately limited.