Fibrin glue in coronary artery bypass grafting operations: casting out the Devil with Beelzebub?

Abstract

In our analysis an increased risk of myocardial injury or even death was found in coronary artery bypass grafting patients when Tissucol fibrin sealant was used intraoperatively.

Extravascular perivenous fibrin support leads to aneurysmal degeneration and intimal hyperplasia in arterialized vein grafts in the rat

“…Our data raise the question whether the possible detrimental effects of local fibrin application on vein grafts contradict the theoretical advantages of drug delivery through local fibrin application. These experimental data are supported by clinical observations showing an unfavorable risk-benefit relation for the intraoperative use of fibrin glue [16,17] …”

A Review of Topical Hemostatic Agents for Use in Cardiac Surgery

“…A note of caution should also be raised in the use of fibrin sealants in coronary artery bypass grafting as Lamm and colleagues [23] have reported an increased risk of myocardial injury or even death in cornary artery bypass grafting patients when Tissucol fibrin sealant was used intraoperatively. They reported that in several cases they had an acute occlusion of bypass grafts after Tissucol was applied in proximity to the anastomoses with immediate embolectomy showing fresh fibrin clot in the lumen of the grafts in each case.…”

Small Vessel Replacement by Human Umbilical Arteries With Polyelectrolyte Film-Treated Arteries

“…Thus, innovative technologies aimed to modify small-diameter natural grafts to obtain functional blood vessels with antithrombogenic and adequate mechanical properties comparable with native vessels constitute challenging research domains and are of the highest clinical importance. Attempts have been made to reduce the inherent thrombogenicity of vascular graft surfaces by autologous fibrin coating (11)(12)(13) or by integrating some of the processes specific to vascular endothelium function such as heparin (14 -16). However, the strongest drawback of the use of heparin remains the risk of heparin-induced thrombocytopenia (17,18).…”