Aortic wall needle extraction: Difference between forceps and needle holder use

Background We investigated the difference in the extracted surfaces between extractions carried out using forceps and a needle holder, focusing on needle extraction manipulation for smaller needle-hole defects. Methods In this prospective observational study, we included patients who underwent aortic surgery at our Hospital between December 2023 and January 2025. Aortic wall samples were collected from the patients with acute type A aortic dissection ( n = 20) and thoracic aortic aneurysm ( n = 20). Two hundred needle holes were created in the samples from each disease type and randomized into two groups: the forceps ( n = 100) and needle holder ( n = 100) groups. The long axis, short axis, and area of needle-hole defects were measured and compared between the two groups. Results Overall, the long axis in the needle holder group was significantly shorter than that in the forceps group (forceps: 0.52 ± 0.18 vs. needle holder: 0.48 ± 0.12 mm, P = 0.036). The short axis was not significantly different between the groups (forceps: 0.26 ± 0.07 vs. needle holder: 0.25 ± 0.06 mm, P = 0.223). The defect area in the needle holder group was significantly smaller than that in the forceps group (forceps: 0.11 ± 0.06 vs. needle holder: 0.09 ± 0.03 mm2, P = 0.022). Acute aortic dissection showed a similar tendency, whereas thoracic aortic aneurysm showed no significant differences. Conclusions The defect area formed when using a needle holder tended to be smaller than that when using forceps, especially in acute aortic dissection. When performing anastomotic pullouts in fragile aortic walls, using a needle holder may help reduce bleeding and prevent distal anastomotic new entry tears.