ABSTRACT 50

ULTRASONIC SUTURE WELDING:  A NOVEL TOOL FOR KNOT-LESS VALVE REPLACEMENT

Marc Ruel, Richard B. Streener and William E. Cohn, Beth Israel Deaconess Medical Center, Boston, MA.

Background:  The difficulty in tying multiple knots with endoscopic instruments constitutes a major technical obstacle to the performance of closed-chest valve surgery.  The following set of experiments was conducted to evaluate the feasibility of using ultrasonic welding as a novel means of knot-less suture fixation during mitral valve replacement (MVR).

Methods:  Four adult swine weighing 48-52 kg underwent MVR with a commercially available mechanical prosthesis (Carbomedics, Austin, TX), using pledgetted interrupted polypropylene sutures.  A newly developed ultrasonic tool (Axya Medical, Beverly, MA) was used to weld the sutures under tension in knot-less loops.  Echocardiographic and visual assessment of the implanted prosthesis was carried out in both under physiologic conditions and during pressurization of the ventricle (LV).

Results*:  All welds were reliably completed and MVR successfully performed in all animals.  Echocardiographic and visual assessment during LV pressurization revealed a well-seated functioning prosthesis in all cases.

Conclusion:  This new technology is reliable in an acute model and constitutes a promising avenue towards facilitation of total endoscopic valve procedures.

*The presentation will include a digital video of the ultrasonic welding procedure