An ex-vivo quantitative assessment to determine the optimal aortotomy closure technique

Journal of Cardiothoracic Surgery

Jehangir J. Appoo¹  Daniel D. Holloway¹ 

[1]Libin Cardiovascular Institiute, University of Calgary, Room C880, 1403 29th Street NW, Calgary T2N-2T9, AB, Canada

关键词: Aortotomy;    Surgical technique;    Aortic surgery;    Animal model;    Cardiovascular surgery;   

Others  :  1224574
DOI  :  10.1186/s13019-015-0325-7

 received in 2014-12-11, accepted in 2015-09-04,  发布年份 2015

【 摘 要 】

Background

After performing an aortotomy, there are a variety of techniques utilized for suture closure. There is no published data comparing the efficacy of various suture techniques. The goal of this study is to provide an ex-vivo quantitative assessment of resistance to leakage and dehiscence for three aortotomy closure techniques.

Materials and methods

An ex-vivo model was developed utilizing explanted porcine aorta. Aortotomies were closed using one of three techniques: 1) single layer baseball stitch 2) double layer baseball stitch 3) horizontal mattress stitch with a top layer baseball stitch. The aorta was pressurized with saline using an apparatus which captured all leaked fluid. The intra-aortic pressure was adjusted over 8 increments from 110 to 375 mmHg. Leakage rates were determined at each pressure level. Ten aortotomies were performed for each technique, resulting in 240 calculated leakage rates.

Results

At all pressures, the horizontal mattress group was measured to have significantly less leakage when compared to single or double layer baseball stitch closures (p < 0.005). There was a trend towards a lower leakage rate in the double layer baseball compared to the single layer baseball stitch. However, this difference is statistically significant only at 300 and 335 mmHg. There were no instances of rupture.

Conclusion

This study provides the first quantitative comparison of three commonly used aortotomy closure techniques. The running horizontal mattress stitch combined with a baseball stitch provides the greatest resistance to leakage at all pressures. This technique may be superior in clinical scenarios with challenging hemostasis.

【 授权许可】

   
2015 Holloway and Appoo.

【 图 表 】

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