1. Synthetic Sealant in Aortic Reconstruction: Clinical Efficacy and Cost Benefit
John A. Goncalves, Jr., MD, FACS
Scott L. Schubach, MD
Winthrop University Hospital

2. Post-Aprotinin Blood-Sparing Protocol
Following global withdrawal of aprotinin, we implemented a blood -sparing protocol at our institution for high-risk aortic reconstructions which included the following:
Aminocaproic Acid
Use of a synthetic surgical sealant for all anastomoses
Anastomotic suture lines should be proactively sprayed with sealant before reinitiating CBP when DHCA is employed and prior to removing the cross-clamp for all other anastomoses.
Sealant is applied to the suture lines when they are asanguinous and not pressurized, thus enhancing optimal polymerization and adherence of the sealant.
Factor VII Rescue PRN

3. Sealant Application 360° coverage of all anastomoses is desirable
May be achieved by rotating treatment site to facilitate exposure of all surfaces

4. DATA AND RESULTS
Patient Demographics

5. Transfusion Requirements: Blood-Sparing Protocol

6. Transfusion Requirements: Aprotinin Controls

7. Perioperative Data: Blood-Sparing Protocol

8. Perioperative Data: Aprotinin Controls

9. Summary Statistics: Transfusion Requirements

10. Summary Statistics: Perioperative Data

11. Summary Statistics: Cost Benefit

12. LIMITATIONS/CONCLUSION
Study Limitations
Sample size limited
Experience at a single institution
Conclusion
In complex aortic reconstruction, use of a synthetic surgical sealant in conjunction with other available systemic hemostatic measures may provide for similar, and even improved, outcomes as well as associated cost benefits as compared to the use of aprotinin alone.