An ex-vivo quantitative assessment to determine the optimal aortotomy closure technique
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RESEARCH ARTICLE
Open Access
An ex-vivo quantitative assessment to determine the optimal aortotomy closure technique Daniel D. Holloway* and Jehangir J. Appoo
Abstract 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. Keywords: Cardiovascular surgery, Animal model, Aortic surgery, Surgical technique, Aortotomy
Background Following a surgical aortotomy, there are a wide variety of suture techniques commonly employed for closure. Most commonly, one of three approaches is used: 1) single layer baseball stitch (aka continuous over-and-over stitch); 2) double layer baseball stitch; or 3) horizontal mattress with second layer baseball stitch [1–3]. The specific closure technique used by each surgeon is determined by the surgeon’s preference within the clinical scenario. Although all of these techniques are commonly used successfully in clinical practice, there is a lack of objective evidence to determine if one technique is superior. Currently, there are no published studies comparing aortotomy closure techniques or recommendations for * Correspondence: [email protected] Libin Cardiovascular Institiute, University of Calgary, Room C880, 1403 29th Street NW, Calgary, AB T2N-2T9, Canada
which approach to take in a given clinical scenario. Each surgeon’s preference appears to be based on their training and personal experiences. Even though they all work well enough to be used clinically, this doe
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