High-strength surgical 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 a number of years 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.
We have reviewed applications and indications of commercial products and include, for the cardiac surgery example below, a list of approved indicated procedures from the European Union, as it illustrates the growing potential for these high-strength glues once they gain universal approval and adoption within the surgical community worldwide.
- 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 specific surgery indications are provided in report S175, "Worldwide Surgical Sealants, Glues, Wound Closure and Anti-Adhesion Markets, 2009-2013" for each of the following surgical fields:
- Digestive tract endoscopy
- General surgery
- Gynecological surgery
- Urological surgery
- Interventional radiology and vascular neuroradiology
- Pediatric surgery
- Pediatric cardiac surgery
- ENT surgery
The unmet need for non-toxic, high-strength, resorbable glues is clearly demonstrated by adoption of existing glue products outside of the United States in these multiple clinical indications.