Dear Editors,
Heterotopic cervical heart transplantation (HT) in mice is a widely used preclinical model in transplant immunology and chronic allograft vasculopathy research [, ]. Although the cuff technique is popular due to its simplicity, it compromises unilateral cerebral blood flow, requires custom-made cuffs, and carries a higher risk of thrombosis and vessel twisting. At our center, we favor manual end-to-side suture anastomosis, as it preserves the continuity of the common carotid artery (CCA) and external jugular vein (EJV), thereby preventing neurological complications and adhering to the 3Rs principle. Moreover, this technique avoids high-velocity arterial jets in the end-to-end grafts and ensures maximum comparability between studies using the abdominal HT model [].
A major technical hurdle of this manual approach is that the CCA lies deep within the body and is widely separated from the EJV, making precise suturing highly challenging, especially in the confined cervical space. To overcome this, we apply a dual-clamp occlusion technique [] (Figure 1A). Two microclamps are used: one placed at the proximal end and one at the distal end, each simultaneously clamping both the CCA and the EJV, physically bringing the two vessels into close proximity and effectively eliminating height mismatch (Figures 1B–E). Additionally, sterile, nonwoven pads moistened with cold saline are placed over the clamp handles. The gentle downward pressure not only keeps the graft cool but also elevates the deeper CCA to the superficial plane. This simple modification makes the artery-first anastomosis and the entire everting suture feasible.
FIGURE 1
Since implementing this refined technique in our established HT program (>1,000 cases since 2010), we have achieved a technical success rate of 83/87 (95.4%) in recent consecutive procedures. Technical success was defined as graft survival with maintained palpable contractility throughout the 100-day observation period (assessed daily by palpation). All 83 successful grafts remained functional during this period, free of thrombosis and other vascular complications. Although manual suturing is generally considered more technically demanding than the cuff method, the total operative time for the recipient (∼25–30 min) was not prolonged. In fact, the anastomosis itself (15–20 min) was faster than cuff installation (20–30 min) []. In our institutional training curriculum for microsurgical transplantation, three surgeons with prior abdominal HT experience achieved consistent success in approximately 3 to 5 procedures, whereas three trainees without a microsurgical background required 50 to 70 operations to become proficient.
While we acknowledge the single-center nature of this study and the lack of a prospective comparison with the cuff technique, we believe this technical modification provides a valuable refinement for cervical HT, particularly for microsurgeons with prior abdominal experience transitioning to the cervical model.
Statements
Data availability statement
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
Ethics statement
The animal study was approved by the Animal Ethics Committee of Tongji Hospital. The study was conducted in accordance with the local legislation and institutional requirements.
Author contributions
XH participated in performing surgery; XZ participated in writing the article. ZW participated in performing surgery and supervising the project. All authors contributed to the article and approved the submitted version.
Funding
The author(s) declared that financial support was not received for this work and/or its publication.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
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References
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AlegreMLAtkinsonCIssaFValujskikhAZhangZJ. Best practices of heart transplantation in mice. Am J Transpl (2025) 25:1820–9. 10.1016/j.ajt.2025.04.012
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PlenterRJZamoraMRGraziaTJ. Four decades of vascularized heterotopic cardiac transplantation in the mouse. J Invest Surg (2013) 26:223–8. 10.3109/08941939.2012.755238
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DunHSticco-IvinsMTeradaYBerningALavineKJKreiselDet alCervical heterotopic heart transplantation in mice using a novel suture technique. JHLT Open (2024) 7:100164. 10.1016/j.jhlto.2024.100164
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HuangXXuXDaiLWangZChengQ. Cervical heterotopic mouse heart transplantation using end-to-side anastomosis technique to study transplant immunology. J Vis Exp (2024) 233:e70704. 10.3791/70704
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OberhuberRCardiniBKoflerMRitschlPOellingerRAignerFet alMurine cervical heart transplantation using the cuff technique. J Vis Exp (2014) 91:e51855. 10.3791/50753
Summary
Keywords
end-to-side anastomosis, heart transplantation, microsurgical technique, mouse model, transplant model
Citation
Huang X, Zhao X and Wang Z (2026) Dual-clamp technique facilitating end-to-side suture anastomosis in murine cervical heart transplantation. Transpl. Int. 39:17404. doi: 10.3389/ti.2026.17404
Received
18 July 2026
Revised
10 August 2026
Accepted
14 August 2026
Published
01 September 2026
Volume
39 - 2026
Updates
Copyright
© 2026 Huang, Zhao and Wang.
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*Correspondence: Zipei Wang, zpwang@tjh.tjmu.edu.cn
†These authors have contributed equally to this work
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