Late Complications of Gelatin-Resorcin-Formalin Glue in the Repair of Acute Type A Aortic Dissection Hiroki Hata, MD, PhD, Hiroshi Takano, MD, PhD, Goro.

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Late Complications of Gelatin-Resorcin-Formalin Glue in the Repair of Acute Type A Aortic Dissection Hiroki Hata, MD, PhD, Hiroshi Takano, MD, PhD, Goro Matsumiya, MD, PhD, Norihide Fukushima, MD, PhD, Naomasa Kawaguchi, PhD, Yoshiki Sawa, MD, PhD The Annals of Thoracic Surgery Volume 83, Issue 5, Pages 1621-1626 (May 2007) DOI: 10.1016/j.athoracsur.2007.01.025 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Actuarial survival curve including hospital mortality. The Annals of Thoracic Surgery 2007 83, 1621-1626DOI: (10.1016/j.athoracsur.2007.01.025) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Actuarial freedom from reoperation curve of all patients and the patients received gelatin-resorcin-formalin (GRF) repairs. (— = total; - - - = GRF (+).) The Annals of Thoracic Surgery 2007 83, 1621-1626DOI: (10.1016/j.athoracsur.2007.01.025) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Sagittal section view of a preoperative cineangiogram (A) and magnetic resonance imaging study (B) in patient 3, revealing a pseudoaneurysm (arrows) that originates from the proximal anastomosis site and is connected with the distal anastomosis site, forming a tunnel behind the prosthetic graft (arrowheads). The Annals of Thoracic Surgery 2007 83, 1621-1626DOI: (10.1016/j.athoracsur.2007.01.025) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Intraoperative photography of patient 3. The ascending aorta and prosthetic graft were longitudinally opened. At both the anastomotic sites, the prosthetic graft has partially detached from the aorta. A tunnel is formed with the pseudoaneurysm behind the prosthetic graft. A pair of thoracic forceps is passed through the pseudoaneurysm tunnel. The outer wall of the pseudoaneurysm consists of surrounding connective tissues, the left atrium, and the pulmonary artery. The Annals of Thoracic Surgery 2007 83, 1621-1626DOI: (10.1016/j.athoracsur.2007.01.025) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Photomicrographs of a longitudinal section of the proximal anastomosis in patient 3 showing disruption and necrosis of the intima and media (arrowheads). Hyaline degeneration and fibrinoid degeneration, as well as local inflammation with macrophage aggregates engulfing the waste tissues (arrows), are observed at the anastomotic site. (A) Hematoxylin and eosin staining. (B), (C) Masson trichrome staining. Original magnification: ×40 (A, B), ×400 (C). (BP = bovine pericardium strip.) The Annals of Thoracic Surgery 2007 83, 1621-1626DOI: (10.1016/j.athoracsur.2007.01.025) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions