Incidence of Valvular Regurgitation and Leaflet Perforation by Using Automated Titanium Fasteners (CORKNOT®) in Heart Valve Repair or Replacement: Less Usual than Reported

Abstract

Background: CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods: Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 136 patients between January 2016 and June 2018. Results: In our study, the mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. 58 patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. The incidence of moderate and/or severe paravalvular leak (PVL) in immediate post-operative echocardiography was found in 7 (5.3%) patients. There were no reported cases of valvular thrombosis leaflet perforation, device dislodgement or embolization during follow-up echocardiography. Single mitral valve and aortic surgeries had comparable incidences of valvular complications. Conclusion: We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.

Using Automated Suture Fastening System For Securing Aortic Cannulation Sites In Minimally-Invasive Mitral Valve Surgery

“…2 Sazzad et al quantified the incidence of valvular complications related to Cor-Knot device. 3 They reported trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography and no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. 3 Lee et al analyzed prosthetic fixation pressures in prosthetic aortic valves, using Digital Pressure Mapping with 2D and 3D pressure maps generated for all valves.…”

“…3 They reported trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography and no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. 3 Lee et al analyzed prosthetic fixation pressures in prosthetic aortic valves, using Digital Pressure Mapping with 2D and 3D pressure maps generated for all valves. None of the 288 Cor-Knot cases had any decrease in intra-suture pressure, while 12 out of 144 manual-tying cases that had pressure drop to less than 80 mmHg which is considered a risk for paravalvular leaks (PVL) (P < 0.001).…”