Novel anastomotic device for the sandwich technique in type A aortic dissections: A human cadaver study

Abstract

Objective: To assess a new aortic anastomotic device for the repair of acute type A aortic dissection (ATAAD) designed to facilitate and expedite ATAAD repair, potentially minimizing the occurrence of distal anastomotic new entry (DANE) and progression of the disease.

Methods: Ten repairs were conducted in an iatrogenically induced ATAAD model using fresh human cadavers and the felt sandwich technique. Five were repaired with conventional 4-0 polypropylene, and 5 were repaired with the new device. With the device, pins were stapled circumferentially through the sandwich and fixed outside with a cap. The sandwich anastomosis was timed. The aortic arch and vascular prosthesis were explanted and connected to a pressure pump filled with glycerol/H₂O solution pressurized at 170/90 mm Hg over 5 minutes. Fluid loss was measured. The anastomoses were checked for DANE, false lumen perfusion (FLP), and dissection progression.

Results: Fifty-four pins (100%) were successfully deployed, with a median of 11 pins (interquartile range [IQR], 10-11.5) per cadaver. Sandwich median time was significantly shorter with the stapler (02:22 [IQR, 01:49-03:05] min/sec vs 06:40 [IQR, 06:23-07:47] min:sec; P = .008). The time for end-to-end anastomosis with the vascular prosthesis (P = .31), as well as measured fluid loss (P = 1.00), were similar in the 2 groups. The suture group showed DANE in 2 specimens, FLP in 3 specimens, and dissection progression in 1 specimen, whereas the stapler group showed none of these conditions. Microscopy showed tearing at stitch channels in all sutured samples and no tears in the stapler group (P = .008).

Conclusions: The new aortic anastomotic device was safe and faster than the conventional technique and may produce more homogeneous and stronger sealing, potentially reducing DANE through less tissue trauma. Further studies in humans are needed to confirm the potential benefits of this novel device.

Keywords: acute type A aortic dissection; anastomotic stapler; circulatory arrest; distal anastomotic new entry; persistent false lumen perfusion; sandwich technique.