Comparison between 3 Aortic Clamps for Video-Assisted Cardiac Surgery: A Histological Study in a Pig Model


  • Fadi Farhat
  • Olivier Metton
  • Françoise Thivolet
  • Olivier Jegaden



Objectives. To assess histological traumatic effects of aortic clamps used in video-assisted surgery, an experimental study was undertaken in a pig model, comparing the Portaclamp, Endoclamp, and a metallic clamp.

Material and Methods. In 3 groups of 5 pigs each, the descending aorta was exposed through a posterolateral left thoracotomy. External clamps (Portaclamp and metallic clamp) were positioned at the middle of the aorta. Endoclamps were inserted at the top of the descending aorta through a small purse and inflated lower. After 60 minutes of clamping, the clamp was removed and the animal reperfused for 60 minutes. It was then sacrificed and the descending aorta was harvested for blind histological study using hemotoxylin-eosin staining of 4 samples per animal: A, before the clamping spot; B, at the clamping spot; C, after the clamping spot; D, a remote sample as control.

Results. In the Portaclamp and metallic clamp groups, there were no lesions of the intima in all aortic samples. In the Endoclamp group, severe lesions of the intima were observed on the clamping spot: endothelium crushing with flattening of cell nucleus (3/5) or endothelium stripping with vanishing of cell nucleus all gathered in 1 point (2/5). Only spongy lesions (clearance between fibers) located on the external third of the media and moderate inflammatory lesions of the adventice were observed with a random distribution in aortic samples without difference between groups.

Conclusions. This study reveals the impressive lesions of the aortic intima due to the Endoclamp. The nonspecific lesions observed in media or adventice may be related to the surgical trauma of the procedure.


Casselman FP, Van Slycke S, Wellens F, et al. 2003. Mitral valve surgery can now routinely be performed endoscopically. Circulation 108(Suppl 1): 1148-54nChitwood WR Jr, Elbeery JR, Moran JF. 1997. Minimally invasive mitral valve repair using transthoracic aortic occlusion. Ann Thorac Surg 63:1477-9nde Canniere D, Dindar M, Stefanidis C, Jegaden O, Jansens JL. 2004. Early experience with a new aortic clamping system designed for port access cardiac surgery: the PortaClamp. Heart Surg Forum 7:E240-4nFelger JE, Chitwood WR Jr, Nifong LW, Holbert D. 2001. Evolution of mitral valve surgery: toward a totally endoscopic approach. Ann Thorac Surg 72:1203-8nGalloway AC, Shemin RJ, Glower DD, et al. 1999. First report of the Port Access International Registry. Ann Thorac Surg 67:51-6nMueller XM, Tevaearai H, Marty B, et al. 2000. Endothelial lesions caused by intra-aortic counterpulsation balloons [in Swiss]. Swiss Surg 6:80-3nReichenspurner H, Detter C, Deuse T, Boehm D, Treede H. Reichart B. 2005. Video and robotic-assisted minimally invasive mitral valve surgery: a comparison of the Port-Access and transthoracic clamp technique. Ann Thorac Surg 79:485-90n



How to Cite

Farhat, F., Metton, O., Thivolet, F., & Jegaden, O. (2006). Comparison between 3 Aortic Clamps for Video-Assisted Cardiac Surgery: A Histological Study in a Pig Model. The Heart Surgery Forum, 9(3), E657-E660.