Development of an anastomotic device for distal anastomosis to achieve marked improvement of total arch replacement

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[Purpose]To achieve marked improvement of graft replacement for aortic arch aneurysm, distal anastomosis must be performed without hemorrhage and in a short time. We developed an anastomotic device for distal anastomosis and conducted a basic experiment to confirm its efficacy. [Methods]The anastomotic device has a mechanism to facilitate mattress sutures. Bovine thoracic aorta and grafts (20 mm and 26 mm in outer diameter) were used. EPTFE felts were used for the outer side of the aorta. The suture needle was 9.0 mm in length and suture threads with straight stitches were used. [Results]1.Thickness of the aortic wall and the certainty of handing over of the needle : Although the needle was handed over accurately by the anastomotic device up to aortic wall thickness of 4.6 mm, difficulties were encountered in some cases with wall thicknesses of 4.8 mm or more. 2.Distance between adjacent mattress sutures : In the case of 2.0 mm, a space between adjacent mattress sutures was found and leakage from the anastomosis site was found in water infusion test. In the cases of 1.0 mm and of 1.0 mm overlap, no penetrating space was found between adjacent mattress sutures. 3.Inter-needle distance of the anastomotic device : With the inter-needle distance of 5.0 mm, there was no problem in the mechanism of needle handing over and no spaces were found between the mattress sutures. With an inter-needle distance of 7.5 mm, the needle bent and the handing over mechanism was disturbed in some cases due to the aortic curvature face and the hardness of the tissues. When there was no overlap of adjacent mattress sutures, spaces were produced between the mattress sutures themselves. [Conclusions]With an inter-needle distance of 5.0 mm and adjacent mattress suture interval of 1.0 mm, the development of anastomotic device in the present study suggested that a clinically useful anastomotic device could be made in the future.