207 An In-Vitro Quantitative Assessment of Hemostasis After Three Commonly Used Aortotomy Closure Techniques

Abstract

After performing aortic valve surgery, there are varying techniques used in clinical practice to close the aortotomy. Although these techniques are used successfully by surgeons every day, there is no published data comparing the efficacy of the techniques. The goal of this study is to provide a quantitative assessment of three commonly used aortotomy closure techniques. An in-vitro model was developed to utilize explanted porcine thoracic aorta. Aortotomies were performed and re-approximated by a single surgeon using one of the three closure techniques: 1) single-layer running baseball stitch 2) double-layer running baseball stitch 3) running horizontal mattress stitch combined with a baseball stitch. The aorta was pressurized with saline in a purpose-built apparatus which captured all leaked fluid for measurement of the leakage rate over time. The intra-aortic pressure was adjusted over 8 increments from 110 mmHg to supra-physiologic levels at 375 mmHg. Leakage rates were measured at each incremental pressure level and compared to previously measured baseline values. Eighteen trials were performed, with six trials in each of the three groups. At all pressures, the horizontal mattress group was measured to have significantly less leakage when compared to single or double baseball stitch closure (p < 0.05). The double layer baseball stitch shows a trend towards decreased leakage compared to the single layer closure. This porcine model 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 throughout the normal, hypertensive, and supra-physiologic aortic pressures. This evidence suggests that this closure technique may provide superior hemostasis and resistance to rupture in the perioperative period.