Use of an Automated Suture Fastening Device in Minimally Invasive Aortic Valve Replacement

Beute, Tyler J.; Oram, Matthew; Schiller, Timothy M.; Goehler, Matthew; Parker, Jessica; Willekes, Charles L.; Timek, Tomasz A.

doi:10.1016/j.athoracsur.2018.01.073

Cited by 14 publications

(30 citation statements)

References 24 publications

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“…In terms of intraoperative outcomes, CPB was reported to be significantly reduced in two studies, one reported no difference and the other was not recorded (Table ). On the other hand, all of the studies reported the application of an automated fastener shortened AXT.…”

Section: Resultsmentioning

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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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: Resultsmentioning

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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“…stroke and transient ischemic attack, PPI, or PVL 9,22,24,30,32 ) as well as length of intensive care unit (ICU) stay. 10,24,30,32 Conflicting evidence is presented regarding length of hospital stay: Plestis et al 24 reported a significant reduction whilst four other studies showed no difference in this outcome. 10,22,30,32 Additionally, two studies measured postoperative aortic valve gradient; in one study, this was significantly reduced in the Cor-Knot cohort, whilst the other reported no difference.…”

Section: Cor-knot In Aortic Valve Surgerymentioning

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%

“…6,10 Indeed, Cor-Knot has been shown to reduce both CPBT 11,19,24,33 and AXT in minimally invasive AVR and MV repair procedures. 11,19,24,32,33 Despite its ergonomic design and demon- Robotic surgery is a rapidly evolving facet of cardiac valve surgery. 38 As in MIVS, a drawback of robotic surgery is the associated increase in CPBT and AXT.…”

Section: Cor-knot In Minimally Invasive and Robotic Surgerymentioning

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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“…al. 3 included 1 incident of stroke (1.9%), 2 incidents (3.8%) of renal failure, 17 incidents (33.0%) of new-onset atrial brillation, 3 incidents (5.7%) of permanent pacemaker insertions and 11 incidents (21.2%) of post-operative transfusion of blood products. Except for renal failure and permanent pacemaker insertions, all reported incidences of post-operative complications were higher or comparable to our study.…”

Section: Post-operative Outcomementioning

confidence: 99%

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

Sazzad

Xian

Ler

et al. 2020

Preprint

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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.

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Use of an Automated Suture Fastening Device in Minimally Invasive Aortic Valve Replacement

Abstract: In mAVR, the CK device was associated with reduced aortic cross-clamp time while providing equivalent clinical outcomes. Larger studies are needed to confirm the efficacy, safety, and cost-effectiveness of the CK device in minimally invasive aortic valve surgery.

Cited by 14 publications

References 24 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

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

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