Aortic Arch Graft Segmentation for Bleeding Reduction
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Solution Overview
Problem
Current aortic arch replacement surgeries face challenges such as prolonged deep hypothermic systemic cardiac arrest due to bleeding from the suture line and difficulties in securing the graft within the descending aorta, which increases the risk of neurologic and organ injury.
Innovation Solution
A total aortic arch reconstruction graft comprising a first cylindrical segment with side branches for the ascending aorta and a second expandable segment with an open-mesh stent for the descending aorta, featuring a collar for secure attachment and reduced suture requirements, allowing for quicker and more precise placement.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If a folded graft is inserted inside the descending aorta by suturing and inverting, then the graft can be secured to the descending aorta, but bleeding from the suture line occurs and requires prolonged deep hypothermic arrest
Solution Approach 1:
The graft is divided into two distinct segments: a proximal segment with a collar for suture attachment to the aorta, and a distal self-expanding stent-graft segment for insertion into the descending aorta. This segmentation allows the sutured collar to be securely fixed while the stent-graft portion provides additional anchoring, reducing suture line bleeding and minimizing the required hypothermic arrest time.
Solution Approach 2:
The collar acts as an intermediary component between the graft and the aorta, providing a secure attachment point for sutures. The self-expanding stent-graft serves as another intermediary that provides radial force against the aortic wall, distributing stress and reducing bleeding from the suture line without requiring prolonged hypothermic arrest.
2Reliability
If conventional sutures are used to attach the graft to the descending aorta, then the graft can be secured, but the probability of suture line bleeding increases
Solution Approach 1:
The graft is divided into a proximal segment with a collar for suture attachment and a distal self-expanding stent-graft segment. This segmentation distributes the attachment function: the collar provides secure suture attachment while the stent-graft provides radial support and reduces stress on the suture line, thereby minimizing bleeding.
Solution Approach 2:
The collar is designed with a curved configuration that conforms to the natural curvature of the aorta, distributing suture tension more evenly across the attachment site. This curved design reduces stress concentration at the suture line, thereby reducing the probability of bleeding compared to straight rigid attachments.
3Reliability
If the collar diameter is trimmed to fit the patient's aorta, then the graft can be secured, but the duration of deep hypothermic arrest increases and secure placement becomes difficult
Solution Approach 1:
The collar is designed with dynamic adjustment capabilities, allowing it to be trimmed or resized intraoperatively to match the patient's specific aortic dimensions. This dynamic adaptability ensures secure placement without requiring excessive trimming time, thereby minimizing the duration of deep hypothermic arrest while maintaining placement security.
Solution Approach 2:
The collar's diameter parameter can be adjusted intraoperatively to match the patient's aortic diameter. This parameter change allows the graft to be securely fitted to various aortic sizes without requiring prolonged trimming procedures, thus reducing hypothermic arrest time while ensuring secure placement.
4Ease of operation
If exposure of the descending aorta is performed, then the graft can be attached, but the procedure becomes much more difficult compared to ascending aorta exposure
Solution Approach 1:
The graft is segmented into a proximal portion with a collar designed for relatively easy attachment to the descending aorta, and a distal self-expanding stent-graft portion that can be inserted and expanded within the descending aorta. This segmentation simplifies the overall procedure by separating the attachment function from the insertion function, making descending aorta exposure and grafting more manageable.
Solution Approach 2:
The distal self-expanding stent-graft portion is designed to self-expand and self-anchor within the descending aorta after insertion, reducing the need for complex manual manipulation and securing procedures. This self-service capability simplifies the surgical procedure compared to fully sutured grafts, making descending aorta exposure and grafting more feasible.
Data Source
AI summary
A total aortic arch reconstruction graft, including a first, hollow cylindrical segment in the shape of an aortic arch, a second, hollow cylindrical segment having a first end joined to the second end of the first segment, and a second end adapted to be inserted into the descending aorta of a patient, the second segment having an expandable outer wall covered with an expandable stent, and a collar having a diameter larger than the diameter of said first segment, the collar located at a juncture where the first end of the second segment is joined to the second end of the first segment, with a plurality of separate, non-absorbable double-armed sutures pre-attached to the collar. A surgical procedure for total replacement of a patient's aortic arch is also disclosed.