Clampless aortic punch system for making a large-diameter access route without side-biting clamp: a preliminary study

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Aortic Disease Research

Background:

• Thoracic endovascular aneurysm repair (TEVAR) is a less-invasive option for aortic aneurysms.
• Hybrid TEVAR often requires aortic clamping, increasing risks of stroke and dissection.
• A need exists for safer methods to create graft access in hybrid TEVAR.

Purpose of the Study:

• To evaluate a novel clampless aortic punch system (APS) for creating graft access in hybrid TEVAR.
• To assess the safety and efficacy of the APS in a swine aorta model.
• To determine the optimal angle for the APS cutter to minimize aortic injury.

Main Methods:

• A clampless aortic punch system (APS) was tested on swine aortas (16-20 mm diameter).
• A Dacron graft was anastomosed, and the APS was used to create a graft access site.
• Three different cutter angles (0°, 15°, 30°) were evaluated for their impact on aortic injury.

Main Results:

• The APS created punched-out lesions ranging from 6-9 mm (median 8 mm).
• The 15° cutter angle resulted in no major vessel injuries, unlike the 0° and 30° angles.
• Histology confirmed minimal disruption to the aortic wall's three-layer structure with the 15° angle.

Conclusions:

• The clampless APS demonstrates potential for reducing stroke and aortic injury risks in hybrid TEVAR.
• The 15° cutter angle appears optimal for safe graft access creation.
• Further animal studies are warranted to confirm the utility of this innovative system.