Prevention vs. Cure: is BioGlue priming the optimal strategy against
E-Vita Neo graft oozing?
Abstract
Background Since the introduction of the E-Vita Open NEO aortic
prosthesis in 2020, several incidences of post-anastomotic oozing from
the polyester portion of the graft have emerged. The use of BioGlue to
prime E-Vita Open NEO to prevent this has been suggested as a way to
mitigate this worrying complication. We investigate the extent of graft
oozing in E-Vita Open NEO and evaluate the use of BioGlue in preventing
oozing, both experimentally and in terms of potential clinical
complications. Methods and materials E-Vita Open NEO (in straight and
branched configurations) was implanted in a perfused model. The distal
stent-graft and side branches were clamped, and the graft pressurised
with blood to 120 mmHg. The volume of blood (ml) oozing from the graft
within 60 seconds was measured. Non-pressurised grafts were coated with
BioGlue up to a thickness 1-, 2-, and 3 mm, and the volume (mm3) of
BioGlue required to do so was recorded. Results Within 60 seconds, 250.0
ml of blood oozed from the grafts tested. 43.694 mm3, 87.389 mm3, and
174.778 mm3 of BioGlue was required to coat the device with 1-, 2-, and
3 mm of BioGlue. Conclusion Graft oozing from E-Vita Open NEO represents
an omnipresent and worrying risk. The use of BioGlue herein is likely
associated with several adverse consequences, which are an additional
risk on top of that posed by graft oozing. These risks call into
question the suitability of E-Vita Open NEO, especially when compared to
alternative devices not affected by oozing.