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Background: While barbed sutures have been extensively utilized in other disciplines, they have not been widely adopted in cardiac surgery. The lack of safety and feasibility data has limited its use within the field. To aide in the further understanding of how cardiac surgeons can use barbed sutures, we sought to develop a high-pressure in vitro simulation model. We compared knotless barbed sutures in a highly pressurized anastomosis to conventional sutures. Methods: Ten specimens in total were utilized in prosthesis anastomosis, using 34 mm Gelweave Plexus (Terumo Aortic, Sunrise, FL 33325, USA) and 34 mm Hemabridge (Intergard Woven Hemabridge, Getinge, Göteborg, Sweden). Five models of size 3-0 barbed suture anastomoses using non-absorbable, barbed, self-retaining, monofilament polypropylene sutures (Filbloc® 3-0, Assut Europe, Rome, Italy) were compared against five conventional anastomoses using size 4-0 polypropylene monofilament (Ethicon, USA). The systems were connected using a novel-designed extracorporeal circulation system. Pressure was rapidly increased in the specimen to a mean pressure of 300–350 mmHg, running then for a minimum of 48 hours to assess anastomosis strength and endurance. Results: No anastomotic dehiscence or rupture was recorded. Complex, angular anastomosis required extra stitch leakage sutures in both conventional and barbed suture specimens. Conclusion: Using knotless barbed sutures with an additional self-locking maneuver for prosthesis-prosthesis anastomosis in cardiac surgery is feasible in an in vitro model under long term, high-mean pressure when compared to conventional sutures. In vivo trials should be performed to further validate the in vitro findings. [ABSTRACT FROM AUTHOR]

John Donne's sermonizing ethos is a masterful creation, incorporating his individuality as poet and priest into a larger identity consonant with his interpretation of Christian doctrine. The role is also consistent with a dense and complicated style that has both troubled and fascinated readers through the centuries. This essay argues that Donne's ethos, while reflecting a penitential stance that has misled some readers, could have been fashioned to reveal his priestly view of Christ, whose image as "Delegate of the Trinity" extends beyond the Gospel into the whole of Scripture and catholic tradition.