Automated Titanium Fasteners Versus Hand-Tied Knots: A Randomized Controlled Trial

Etiwy, Muhammad; Javadikasgari, Hoda; Houghtaling, Penny L.; Gillinov, Marc

doi:10.1016/j.athoracsur.2018.05.022

Cited by 13 publications

(27 citation statements)

References 4 publications

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“…Whilst there have been no formal cost analysis studies on the use of Cor‐Knot, there is mild cost increase in valve procedures by $58 per application which may balance out against the total cost savings from reducing the operative times, potential complications, and ICU stay . At present, it is controversial to conclude if Cor‐Knot is economically favorable in cardiac valve surgery . On the other hand, a further important quality of Cor‐Knot is the reportedly reduced learning curve meaning that less experienced surgeons and trainees can attain proficiency quicker and with reduced operative times, ultimately .…”

Section: Discussionmentioning

confidence: 99%

“…On average, the use of Cor‐Knot has been found to shorten AXT up to 20 minutes in heart valve surgeries . However, total hand‐tied knotting times in AVR and MV surgery are approximately 15 and 5 minutes, respectively . The discrepancy between time savings in total knotting times and AXT is speculated to be a result of Cor‐Knot conferring lower rate of intraoperative complications which require further intervention during the operation .…”

Section: Discussionmentioning

confidence: 99%

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What is the safety and efficacy of the use of automated fastener in heart valve surgery?

et al. 2019

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Introduction: Cor-Knot automated fastener has been used as an adjunct in heart valve surgery to eliminate the need for manual tying during valve implantation. Although reduced operative time and facilitation for minimally invasive surgery are clear benefits, whether their use translates to improved patient outcome remains debatable. This study aims to review the safety and efficacy of automated fasteners in heart valve surgeries. Method: Specific searches were conducted via online medical databases (Pubmed, Embase, Ovid) between 1950 and June 2019. Longitudinal studies were included that provided operative parameters. Results: The initial literature search identified 3773 articles, but only eight met the inclusion criteria and were used for analysis: four studies related to aortic valve replacement (AVR), four related to mitral valve (MV) intervention (total n = 810). The meta-analysis revealed the significantly shorter aortic cross-clamp time in the Cor-knot group compared to manual tying, both in AVR and MV surgeries (P < .05). Cardiopulmonary bypass time was significantly shorter in the Cor-knot group when analyzing studies in MV surgery (weighted mean difference [WMD]: 110.0; 95% confidence interval: 12.3-207.7; P = .027) The use of Cor-Knot did not increase the risk of permanent pacemaker implantation, paravalvular leak, and 30-day mortality. The majority of studies reported no change in the length of intensive unit care and total hospital stay. Conclusion:We confirmed that the majority of existing literatures indicated the safety and intraoperative efficacy with automated fastener application. Nevertheless, there is currently no evidence to support automated fastened sutures can translate its intraoperative advantages to improved patient outcome. K E Y W O R D S aortic, automated fastener, clinical review, cor-knot, heart valves, mitral 1 | BACKGROUND Surgery for valvular heart disease is well-established and remains a superior treatment option for many valvular pathologies in many patient groups. Both replacement (with prosthetic valves) and repair Abbreviations: AS, aortic stenosis; AVR, aortic valve replacement; AXT, aortic cross-clamp time; CPB, cardiopulmonary bypass time; ICU, intensive care unit; LV, left ventricular; Mini-AVR, minimally invasive aortic valve replacement; Mini-MV repair, minimally invasive mitral valve repair; MR, mitral regurgitation; MV, mitral valve; PPI, permanent pacemaker implantation; PVL, paravalvular leak; TAVR, transcatheter aortic valve replacement. Lueh Chien and M. Yousuf Salmasi are Joint first authors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

What is the safety and efficacy of the use of automated fastener in heart valve surgery?

et al. 2019

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“…7,26 Provided training is undertaken, Cor-Knot is associated with a short learning curve, enabling surgeons to quickly and effectively obtain proficiency and integrate its use into their daily practise. 27 This has particular relevance to MIVS, whose technically challenging nature often results in increased operating times, leading many surgeons to favor sternotomy. Cor-Knot may negate this additional operating time, thereby supporting surgeons in the transition from sternotomy to minimally invasive approaches.…”

Section: Indications Benefits and Shortcomings Of Cor-knotmentioning

confidence: 99%

“…11,33 With respect to CPBT and AXT, four of the five studies independently found these times to be reduced by Cor-Knot, a finding that was further supported by a meta-analysis. 6,11,19,27,33,34 30 -RCT Perin et al 9 -PCS Wang et al 9 -RCS Morgant et al 10 -PCS Length of ICU stay No significant difference Lee et al 30 -RCT No significant difference Grapow et al 11 -RCS Plestis et al 24 -RCS Perin et al 19 -PCS Beute et al 32 -RCS Morgant et al 10 -PCS Abbreviations: AXT, aortic cross clamp time; AVR, aortic valve replacement; CPBT, cardiopulmonary bypass time; ICU, intensive care unit; MA, meta-analysis; MV, mitral valve; PCS, prospective cohort study; PPI, permanent pacemaker implantation; PVL, paravalvular leak; RCS, retrospective cohort study; RCT, randomized controlled trial.…”

Section: Cor-knot In Mitral Valve Surgerymentioning

confidence: 99%

“…However, only two studies to date explore the role of this novel device in the context of a randomized controlled trial (RCT). 20,27 The remaining studies are either Future studies should also evaluate the benefits of Cor-Knot in specific patient sub-groups. For instance, given that reduced AXT has been shown to confer a greater benefit to those with a left ventricular ejection fraction of ≤40% and diabetic patients, the employment of Cor-Knot may serve to improve outcomes particularly in these patient sub-groups.…”

Section: Implications For the Futurementioning

confidence: 99%

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The role of Cor‐Knot in the future of cardiac surgery: A systematic review

Jenkin

Prachee

Sokal

et al. 2020

Journal of Cardiac Surgery

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Objective: The Cor-Knot automated fastener has been used to eliminate the need for manual knot-tying in cardiac valve surgery for over a decade. We review the current literature pertaining to Cor-Knot and discuss its benefits and shortcomings with respect to cardiac valve surgery. Methods: A comprehensive literature search was conducted to identify articles discussing the use of automated fasteners and manually tied knots in the setting of cardiac valve surgery. The search terms used were "heart", "valve surgery", "cardiac", "Cor-Knot", "fastener", "automated fastener", "aortic valve", "mitral valve", "minimally invasive", and "titanium". These terms were used as keywords and, in combination, as MeSH terms to maximize the output of literature searches. Twenty-four relevant articles were identified and reviewed. Results: Current literature provides evidence to support the role of Cor-Knot in facilitating enhanced intraoperative efficacy by reducing total operation times as compared with manual knot-tying. However, studies to date fail to provide evidence for the translation of these intraoperative advantages into improved patient outcomes. Moreover, Cor-Knot is associated with a significant financial burden. Conclusion: A plethora of evidence exists to support the intraoperative advantages provided by Cor-Knot. However, the literature is yet to support its role in facilitating superior clinical outcomes as compared with manual knot tying. Larger high-quality trials and studies are required to provide evidence supporting the ongoing use of Cor-Knot in valve surgery.

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Cor‐Knot automated fastener in distal anastomosis of total aortic arch replacement: A case report

Sharaf

Martin

Jeng

2021

Clinical Case Reports

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Automated Titanium Fasteners Versus Hand-Tied Knots: A Randomized Controlled Trial

Abstract: Using the automated fastener to facilitate annuloplasty fixation through a sternotomy resulted in a small procedural time savings (average of 10 s/stitch) that had no overall impact on cardiopulmonary bypass or cross-clamp times but added an average cost of $1,026 to the operation.

Cited by 13 publications

References 4 publications

What is the safety and efficacy of the use of automated fastener in heart valve surgery?

What is the safety and efficacy of the use of automated fastener in heart valve surgery?

The role of Cor‐Knot in the future of cardiac surgery: A systematic review

Cor‐Knot automated fastener in distal anastomosis of total aortic arch replacement: A case report

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