High-strength glue products were approved for topical closure applications in the United States in the late 1990s. Outside the United States, high-strength glues and adhesives have been approved in some countries for an even longer period of time and have built up a track record of use in internal surgery. With time, high-strength glues will come to be used in a wider range of procedures and enable new procedures to be performed more economically with better outcomes and reduced morbidity and mortality.
Applications and indications of high-strength medical and surgical glues are replete, with approved applications in nearly every clinical field. Below is a subset of that list, specifically of approved indicated procedures in cardiac surgery.
- Augmentation of aortic and vascular sutures.
- Repair of minor epicardial lacerations without the use of sutures.
- Hemostasis and reinforcement of anastomoses of coronary bypass and as an adhesive to optimize and secure the path of coronary bypasses on the heart.
- Coating of perianeurysmatic tissue in ventricular aneurysm surgery.
- Reinforcement of sutures and patch adhesion in reduction of the left ventricle.
- As an adhesive to secure the dissection plane in acute aortic dissections.
- As a hemostatic agent in the prevention of bleeding of proximal and distal anastomoses in acute aortic dissections.
- As an adhesive for gluing patches for dissected aorta reinforcement.
- As a hemostatic agent on anastomoses in aortic valve surgery, particularly in the presence of calcific or atheromatous aortas.
- Hemostasis and reinforcement of sutures after aortic aneurysm repair.
- In re-operations, as a hemostatic adhesive on lacerations of the ventricle caused by re-sternotomy or the presence of adhesions.
Other clinical areas with specific applications currently using high strength glues include digestive tract endoscopy, neurosurgery, general surgery, gynecologic surgery, urologic surgery, interventional radiology and vascular neuroradiology, pediatric general surgery, pediatric cardiac surgery, and ENT surgery.
These products have high-strength sealant and adhesive properties that will lead to their increasing adoption by clinical practitioners worldwide, starting with surgical closure and specific internal procedures for which there is no alternative. We expect that this will be followed, in the next five years, by increasing usage for gluing of tissues in vascular, neurological, spinal, orthopedic, and other procedures. We also envisage the introduction of new products and technologies that are under development to address the failings of existing first- generation high-strength glue products, to make them less toxic, more resorbable, and with higher strength.
The unmet need for non-toxic, high-strength, resorbable glues is clearly demonstrated by adoption of existing glue products outside of the United States.
See Report #S180, "Worldwide Surgical Sealants, Glues, Wound Closure and Anti-Adhesion Markets, 2008-2015."