# Enhancing aortic anastomotic integrity: ex vivo evaluation of reinforcement techniques using Teflon-felt sandwich with mattress sutures

## TL;DR

This study tested different suturing techniques for aortic surgery and found that using Teflon-felt with mattress sutures provides the strongest results.

## Contribution

The study introduces a novel Teflon-felt sandwich combined with mattress sutures to enhance aortic anastomotic strength.

## Key findings

- Group D (Teflon-felt with mattress sutures) showed significantly higher tensile strength than other techniques.
- Fractures in Group D occurred near the Teflon suture, indicating better structural integrity.
- The Teflon-felt technique shows potential for improving surgical outcomes in aortic procedures.

## Abstract

The success of aortic surgery depends on the durability and hemostatic properties of anastomotic techniques to prevent complications such as bleeding, thromboembolic events, and anastomotic disruption. This study evaluated the tensile strength of different suturing techniques ex vivo to assess their suitability for aortic procedures.

Aortic wall specimens were obtained from porcine ascending aortae and anastomosed to vascular grafts using a 5–0 polypropylene monofilament suture. Four different suturing techniques were evaluated: simple interrupted sutures (Group A, n = 14), simple interrupted sutures with adventitial inversion and horizontal mattress sutures (Group B, n = 14), simple interrupted sutures with a Teflon-felt sandwich (TFS) (Group C, n = 14), and simple interrupted sutures with a TFS combined with horizontal mattress sutures (Group D, n = 14). The maximum tensile strength of each anastomosis was assessed.

The simple interrupted suture technique incorporating a TFS with horizontal mattress sutures (Group D) demonstrated significantly superior tensile strength compared with the other techniques (P < 0.001). Notably, in this group, the fracture site was near the Teflon horizontal mattress suture, whereas in the other groups, fractures occurred adjacent to the simple interrupted sutures.

The TFS technique demonstrated superior tensile resilience among the studied methods, suggesting its potential advantage in aortic surgery. These findings provide a strong theoretical foundation for optimizing anastomotic techniques and warrant further in vivo investigation to validate their clinical applicability in enhancing surgical outcomes.

The online version contains supplementary material available at 10.1007/s12055-025-02043-1.