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

## TL;DR

This study compares three techniques for closing aortotomies and finds that a horizontal mattress stitch with a baseball stitch reduces leakage the most.

## Contribution

The first quantitative ex-vivo comparison of aortotomy closure techniques is presented.

## Key findings

- The horizontal mattress stitch with a baseball stitch significantly reduced leakage at all pressures compared to other techniques.
- Double layer baseball stitches showed lower leakage than single layer ones at higher pressures.
- No ruptures occurred in any of the tested techniques.

## Abstract

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.

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.

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.

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.