Use of an automated knot fastener shortens operative times in minimally invasive mitral valve repair

Abstract

Introduction Longer durations of cardiopulmonary bypass and aortic cross clamp are associated with increased morbidity and mortality. Little is known about the effect of automated knot fasteners (Cor-Knot®) in minimally invasive mitral valve repair on operative times and outcomes. The aim of this study was to evaluate whether these devices shortened cardiopulmonary bypass and aortic cross clamp times and whether this impacted on postoperative outcomes. Materials and methods All patients undergoing isolated minimally invasive mitral valve repair by a single surgeon between March 2011 and March 2016 were included (n = 108). Two cohorts were created based on the use (n = 52) or non-use (n = 56) of an automated knot fastener. Data concerning intraoperative variables and postoperative outcomes were collected and compared. Results Preoperative demographics were well matched between groups with no significant difference in logistic Euroscore (manual vs automated: median 3.1, interquartile range, IQR, 2.1–5.5, vs 5.4, IQR 2.2–8.3; P = 0.07, respectively). Comparing manually tied knots to an automated fastener, cardiopulmonary bypass and aortic cross clamp times were significantly shorter in the automated group (cardiopulmonary bypass: median 200 minutes, IQR 180–227, vs 165 minutes (IQR 145–189 minutes), P < 0.001; aortic cross clamp 134 minutes (IQR 121–150 minutes) vs 111 minutes (IQR 91–137 minutes), P < 0.001, respectively). There was no mortality and no strokes, nor were there any differences in postoperative outcomes including reoperation for bleeding, renal failure, intensive care or hospital stay. Conclusions The use of an automated knot fastener significantly reduces cardiopulmonary bypass and aortic cross clamp times in minimally invasive mitral valve repair but this does not translate into an improved clinical outcome.

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

“…Whilst the patients in the studies from this review had on average good ventricular function, the reduction in CPB and AXT offered by Cor‐Knot makes it particularly applicable for patients with a poor ventricular function who are otherwise high‐risk for valvular surgery . Despite this, we did not find evidence that the application of Cor‐Knot confers improved clinical outcomes, including an equivalence in the length of total in‐hospital stay and ICU stay . On the other hand, the lack of power in the studies may be the reason why an improved patient outcome conferred by Cor‐Knot is yet to be detected …”

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

“…7 It functions as an alternative to the more conventionally employed endoscopic knot pusher, the use of which is more time consuming, has greater inter-user variability, and is prone to producing loose ('air') knots (whose correction often prolongs operations). 19 Cor-Knot essentially eliminates these pitfalls whilst also reducing the time taken to fasten and trim sutures. It is most commonly employed in aortic valve replacement (AVR) and mitral valve (MV) repair.…”

“…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.…”

“…35 The operation, particularly with respect to structures that are more difficult to access, given their location deep in the thorax. 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.…”

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

“…The CORKNOT® device is an automated titanium suture fastening system used predominantly in minimally invasive cardiac surgery. The CORKNOT® device has been reputed for its bene ts in terms of strength, security and reliability 1,2 . It is an ergonomic device that allows automatic crimping and trimming of sutures with a single squeeze.…”