Fibrin Glue and Topical Hemostasis in Cardiac Surgery

  • David C. Mair
  • John P. Miller
  • Paul D. Mintz


Technical limitations of suturing have provided the impetus behind the search for improved methods of providing surgical hemostasis, sealing anastomoses, and bonding tissues. Incompatibility of the suture material with tissues may trigger an inflammatory response, resulting in tissue damage around the suture site. Sutures placed in fragile tissue can lead to necrosis and dehiscence of wounds. Technologies employed to partially overcome these problems include the use of improved suture materials, cauterization, metallic staples or clips, and a variety of adhesive/hemostatic agents. A surgical glue should provide atraumatic and expedient tissue sealing and bonding. The search for the ideal sealant prompted the development of both natural and synthetic products such as fibrin glue, collagen pledgets, absorbable gelatin sponges, oxidized cellulose, and cyanoacrylate derivatives. Fibrin glue is an excellent hemostatic agent as it is readily resorbed and has minimal tissue toxicity.


Fibrin Glue Fibrin Sealant Mitral Valve Repair Oxidize Cellulose Needle Hole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tidrick R, Warner E. Fibrin fixation of skin transplants.Surgery 1944;15:90–95.Google Scholar
  2. 2.
    Cronkite E, Lozner E, Deaver J. Use of thrombin and fibrinogen in skin grafting.JAMA 1944;124:976–978.Google Scholar
  3. 3.
    Matras H. Fibrin seal: the state of the art.J Oral Maxillofac Surg 1985;43:605–611.PubMedCrossRefGoogle Scholar
  4. 4.
    Siedentop K, Harris D, Sanchez B. Autologous fibrin tissue adhesive: factors influencing bonding power.Laryngoscope 1988;98:731–733.PubMedCrossRefGoogle Scholar
  5. 5.
    Saltz R, Sierra D, Feldman D, et al. Experimental and clinical applications of fibrin glue.Plast Reconstr Surg 1991;88:1005–1015.PubMedCrossRefGoogle Scholar
  6. 6.
    Wan H, Huang S, Floyd D, et al. Is the amount of fibrinogen in cryoprecipitate adequate for fibrin glue? Introducing an improved recycled cryoprecipitate method. Transfusion 1989;29(Suppl):41S.Google Scholar
  7. 7.
    Gibble J, Ness P. Fibrin glue: the perfect operative sealant?Transfusion 1990;30:741–747.PubMedCrossRefGoogle Scholar
  8. 8.
    Toriumi D, O’Grady K. Surgical tissue adhesives in otolaryngology-head and neck surgery.Otolaryngol Clin North Am 1994;27:203–209.PubMedGoogle Scholar
  9. 9.
    Ishitani M, McGahren E, Sibley D, et al. Laparoscopically applied fibrin glue in experimental liver trauma.J Pediatr Surg 1989;24:867–871.PubMedCrossRefGoogle Scholar
  10. 10.
    McCarthy P. Fibrin glue in cardiothoracic surgery.Transf Med Rev 1993;8:173–179.CrossRefGoogle Scholar
  11. 11.
    Papatheofanis F, Barmada R. The principles and applications of surgical adhesives.Surg Ann 1993;25:49–81.Google Scholar
  12. 12.
    Shaffrey C, Spotnitz W, Shaffrey M, et al. Neurosurgical applications of fibrin glue: augmentation of dural closure in 134 patients.Neurosurgery 1990;26:207–210.PubMedCrossRefGoogle Scholar
  13. 13.
    Errett L, Walsh G. Life salvage with fibrin glue in three cases of exsanguinating hemorrhage.Can J Surg 1986;29:214–216.PubMedGoogle Scholar
  14. 14.
    Dresdale A, Rose E, Jeevanandam V, et al. Preparation of fibrin glue from single–donor fresh-frozen plasma.Surgery 1985;97:750–755.PubMedGoogle Scholar
  15. 15.
    Blood collection storage and component preparation. In: Walker R, ed. Technical Manual 11th ed. Bethesda: American Association of Blood Banks, 1993;717–747.Google Scholar
  16. 16.
    Stemberger A, Blümel. Fibrinogen-fibrin conversion and inhibition of fibrinolysis.Thorac Cardiovasc Surg 1982;30:209–214.PubMedCrossRefGoogle Scholar
  17. 17.
    Ciano P, Colvin R, Dvorak A, et al. Macrophage migration in fibrin gel matrices.Lab Invest 1986;54:62–70.PubMedGoogle Scholar
  18. 18.
    Houston K, Rotstein O. Fibrin sealant in high-risk colonic anastomoses.Arch Surg 1988;123:230–234.PubMedGoogle Scholar
  19. 19.
    Byrne D, Hardy J, Wood R, et al. Effect of fibrin glues on the mechanical properties of healing wounds.Br J Surg 1991;78:841–843.PubMedCrossRefGoogle Scholar
  20. 20.
    Spotnitz W, Mintz P, Avery N, et al. Fibrin glue from stored human plasma.Am Surg 1987;53:460–462.PubMedGoogle Scholar
  21. 21.
    Weis-Fogh U. Fibrinogen prepared from small blood samples for autologous use in a tissue adhesive system.Eur Surg Res 1988;20:381–389.PubMedCrossRefGoogle Scholar
  22. 22.
    Kjaergard H, Weis-Fogh U, S;ohrensen H, et al. A simple method of preparation of autologous fibrin glue by means of ethanol.Surg Gynecol Obstet 1992;175:72–73.PubMedGoogle Scholar
  23. 23.
    DePalma L, Criss V, Luban N. The preparation of fibrinogen concentrate for use as fibrin glue by four different methods.Transfusion 1993;33:717–720.PubMedCrossRefGoogle Scholar
  24. 24.
    Harris D, Siedentop K, Ham K, et al. Autologous fibrin tissue adhesive biodegradation and systemic effects.Larynogoscope 1987;97:1141–1144.Google Scholar
  25. 25.
    Pipan C, Glasheen W, Matthew T, et al. Effects of antifibrinolytic agents on the life span of fibrin sealant.J Surg Res 1992;53:402–407.PubMedCrossRefGoogle Scholar
  26. 26.
    Ismal S, Glasheen W, Gonias S, et al. Bovine fibrin sealant: the intraperitoneal life span of a new hemostatic agent.Am Coll Surg 1993;44:572–574.Google Scholar
  27. 27.
    Rousou J, Engelman R, Breyer R. Fibrin glue: an effective hemostatic agent for nonsuturable intraoperative bleeding.Ann Thorac Surg 1984;38:409–410.PubMedCrossRefGoogle Scholar
  28. 28.
    Matthew T, Spotnitz W, Korn I, et al. Four years’ experience with fibrin sealant in thoracic and cardiovascular surgery.Ann Thorac Surg 1990;50:40–44.PubMedCrossRefGoogle Scholar
  29. 29.
    Baker J, Spotnitz W, Nolan S. A technique for spray application of fibrin glue during cardiac operations.Ann Thorac Surg 1987;43:564–565.PubMedCrossRefGoogle Scholar
  30. 30.
    Joyce D, McGrath L, Gonzalez-Lavin L. A method of applying fibrin sealant using an atomizing agent.Ann Thorac Surg 1989;47:320.PubMedCrossRefGoogle Scholar
  31. 31.
    Redl H, Schlag G, Dinges H. Methods of fibrin seal application.Thorac Cardiovasc Surg 1982;30:223–227.PubMedCrossRefGoogle Scholar
  32. 32.
    Borst H, Haverich A, Walterbusch G, et al. Fibrin adhesive: an important hemostatic adjunct in cardiovascular operations.Thorac Cardiovasc Surg 1982;84:548–553.Google Scholar
  33. 33.
    Lerner R, Binur N. Current research review. Current status of surgical adhesives.J Surg Res 1990;48:165–181.PubMedCrossRefGoogle Scholar
  34. 34.
    Spotnitz W, Dalton S, Baker J, et al. Reduction of perioperative hemorrhage by anterior mediastinal spray application of fibrin glue during cardiac operations.Ann Thorac Surg 1987;44:529–531.PubMedCrossRefGoogle Scholar
  35. 35.
    Gundry S, Behrendt D. A quantitative and qualitative comparison of fibrin glue, albumin, and blood as agents to pretreat porous vascular grafts.J Surg Res 1987;43:75–77.PubMedCrossRefGoogle Scholar
  36. Moront M, Katz N, O’Connell J, et al. The use of topical fibrin glue at cannulation sites in neonates.Surg Gynecol Obstet 358–359.Google Scholar
  37. 37.
    Di Lello F, Mullen D, Flemma R. Sutureless fixation of long aortocoronary saphenous vein grafts with oxidized regenerated cellulose.Ann Thorac Surg 1989;47:473–474.PubMedCrossRefGoogle Scholar
  38. 38.
    Rousou J, Gonzalez-Lavin L, Cosgrove D, et al. Randomized clinical trial of fibrin sealant in patients undergoing resternotomy or reoperation after cardiac operations.J Thorac Cardiovasc Surg 1989;97:194–203.PubMedGoogle Scholar
  39. 39.
    Clark D, Drohan W, Miekka S, et al. Strategy for purification of coagulation factor concentrates.Ann Clin Lab Sci 1989;19:196–207.PubMedGoogle Scholar
  40. 40.
    Burnouf-Radosevich M, Burnouf T, Huart J. Biochemical and physical properties of a solvent-detergent-treated fibrin glue.Vox Sang 1990;58:77–84.PubMedCrossRefGoogle Scholar
  41. 41.
    Lupinetti F, Stoney W, Alford W, et al. Cryoprecipitate-topical thrombin glue.J Thorac Cardiovasc Surg1985;90:502–505.PubMedGoogle Scholar
  42. 42.
    Kram H, Bansal M, Timberlake O, et al. Antibacterial effects of fibrin glue-antibiotic mixtures.J Surg Res 1991;50:175–178.PubMedCrossRefGoogle Scholar
  43. 43.
    Bänninger H, Hardegger T, Tobler A, et al. Fibrin glue in surgery: frequent development of inhibitors of bovine thrombin and human factor V.Br J Haemost 1993;85:528–532.CrossRefGoogle Scholar
  44. 44.
    Berruyer M, Amiral J, Ffrench P, et al. Immunization by bovine thrombin used with fibrin glue during cardiovascular operations.J Thorac Cardiovasc Surg 1993;105:892–897.PubMedGoogle Scholar
  45. 45.
    Milde L. An anaphylactic reaction to fibrin glue.Anesth Analg 1989;69:684–686.PubMedGoogle Scholar
  46. 46.
    Berguer R, Staerkel R, Moore E, et al. Warning: fatal reaction to the use of fibrin glue in deep hepatic wounds. Case reports.J Trauma 1991;31:408–411.PubMedCrossRefGoogle Scholar
  47. 47.
    Barton B, Moore E, Pearce W. Fibrin glue as a biologic vascular patch—a comparative study.J Surg Res 1986;40:510–513.PubMedCrossRefGoogle Scholar
  48. 48.
    Stark J, de Leval M. Experience with fibrin seal (Tisseel) in operations for congenital heart defects.Ann Thorac Surg 1984;38:411–413.PubMedCrossRefGoogle Scholar
  49. 49.
    Ennker I, Ennker J, Schoon D, et al. Formaldehyde-free collagen glue in experimental lung gluing.Ann Thorac Surg 1994;57:1622–1627.PubMedCrossRefGoogle Scholar
  50. 50.
    Vincent J, Skotnicki S, van der Meer J, et al. Resorbable suture support for ventricular aneurysmectomy.J Thorac Cardiovasc Surg 1987;94:430–433.PubMedGoogle Scholar
  51. 51.
    Feikes H, Daugharthy J, Perry J, et al. Preservation of all chordae tendineae and papillary muscle during mitral valve replacement with a tilting disc valve.J Cardiac Surg 1990;5:81–85.CrossRefGoogle Scholar
  52. 52.
    Dilip K, Vachaspathy P, Clarke B, et al. Haemolysis following mitral valve repair.J Cardiovasc Surg 1992;33:568–569.Google Scholar
  53. 53.
    Shapira N. An alternative to felt pledgets in cardiac surgery.Ann Thorac Surg 1986;41:219–221.PubMedCrossRefGoogle Scholar
  54. 54.
    Borst H. Dire consequences of the indiscriminate use of Teflon felt pledgets.J Thorac Cardiovasc Surg 1987;94:442–443.PubMedGoogle Scholar
  55. 55.
    Bojar R, Payne D, Sheffield A, et al. Successful repair of postoperative ascending aortic mycotic false aneurysms using circulatory arrest.Ann Thorac Surg 1988;46:182–186.PubMedCrossRefGoogle Scholar
  56. 56.
    Barbalinardo R, Citrin P, Franco C, et al. A comparison of isobutyl 2-cyanoacrylate glue, fibrin adhesive, and oxidized regenerated cellulose for control of needle hole bleeding from polytetrafluoroethylene vascular prostheses.J Vase Surg 1986;4:220–223.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 1998

Authors and Affiliations

  • David C. Mair
  • John P. Miller
  • Paul D. Mintz

There are no affiliations available

Personalised recommendations