Comparison of Automated Titanium Fasteners to Hand-Tied Knots in Open Aortic Valve Replacement

Lee, Candice Y.; Johnson, C. Anderson; Siordia, Juan A.; Lehoux, Juan; Knight, Peter A.

doi:10.1177/155698451801300105

Cited by 5 publications

(24 citation statements)

References 15 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%

“…On the other hand, all of the studies reported the application of an automated fastener shortened AXT. As AXT was reported in all four AVR studies, this was amenable to meta‐analysis (Figure ), confirming a significantly reduced AXT in the Cor‐Knot group compared to manual (weighted mean difference [WMD]: 86.622; 95% confidence interval [CI]; 15.9‐157.4; P = .016), In addition, one study recorded total operation time and showed it was in favor of the automated fastener implementation . For operative mortality, a meta‐analysis of the four studies revealed no significant difference between the Cor‐Knot or manually tied groups (Figure ; odds ratio: 1.73; 95% CI: 0.50‐6.02; P = .678).…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…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 . This has particular relevance for patients who are high‐risk for surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Whilst the Cor‐Knot titanium fastener only a novel adjunct to heart valve surgery, many aspects of safety have been demonstrated. The 30‐day mortality rate between conventional knot tying and the use of Cor‐Knot is equivalent based on the RCTs and retrospective studies we have analyzed . Importantly, the use of Cor‐Knot in heart valve surgery is not associated with postoperative complications including the risk of PPI and PVL .…”

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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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Titanium Fastener Utilization during HeartMate 3 Left Ventricular Assist Device Implantation

Johnson

Melvin

Robinson

et al. 2018

Innovations�(Phila)

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Objective The objective of this study was to investigate the feasibility of using titanium fasteners for securement of the inflow sewing ring during HeartMate 3 implantation. The secondary objective was to compare cardiopulmonary bypass and total operative times between the titanium fastener and hand-tied knot groups. Methods Clearance between the sewing ring and the HeartMate 3 device was assessed in vitro. Thirty-one patients undergoing HeartMate 3 implantation via median sternotomy at a single center from April 2017 to February 2018 were reviewed. The sewing ring was secured with hand-tied knots (n = 18) or titanium fasteners (n = 13). Cannulation strategy and implantation technique were otherwise identical between groups. Central arterial and venous cannulation was performed for cardiopulmonary bypass. The left ventricular apex was cored, and the sewing ring was attached with hand-tied knots or titanium fasteners. Results There was adequate clearance for the titanium fastener to secure the inflow sewing ring and then connect to the HeartMate 3 in vitro. The inflow sewing ring was successfully secured during HeartMate 3 implantation in the titanium fastener group. Cardiopulmonary bypass time was 75 and 92 minutes for the titanium fastener and hand-tied groups, respectively ( P < 0.03). Total operative time was 177 and 193 minutes for the titanium fastener and hand-tied groups, respectively ( P = 0.513). Conclusions The inflow sewing ring of the HeartMate 3 was efficiently secured using titanium fasteners. Titanium fasteners resulted in shorter cardiopulmonary bypass times compared with the hand-tied group. There was no difference in total operative time.

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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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Comparison of Automated Titanium Fasteners to Hand-Tied Knots in Open Aortic Valve Replacement

Cited by 5 publications

References 15 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?

Titanium Fastener Utilization during HeartMate 3 Left Ventricular Assist Device Implantation

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

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