Automated Fastener vs Hand-tied Knots in Heart Valve Surgery: A Systematic Review and Meta-analysis

Faizus Sazzad; Ashlynn Ler; Michał Kuzemczak; Sheryl Ng; Andrew M T L Choong; Theo Kofidis

doi:10.1016/j.athoracsur.2020.08.117

Automated Fastener vs Hand-tied Knots in Heart Valve Surgery: A Systematic Review and Meta-analysis

Ann Thorac Surg. 2021 Sep;112(3):970-980. doi: 10.1016/j.athoracsur.2020.08.117. Epub 2020 Dec 8.

Authors

Faizus Sazzad¹, Ashlynn Ler², Michał Kuzemczak³, Sheryl Ng⁴, Andrew M T L Choong¹, Theo Kofidis⁵

Affiliations

¹ Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore.
² Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre, Singapore; School of Medicine, National University of Ireland, Galway, Ireland.
³ Division of Emergency Medicine, Department of Medical Rescue, Poznan University of Medical Sciences, Poznań, Poland; Peter Munk Cardiac Centre, Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Canada.
⁴ Cardiovascular Research Institute, National University of Singapore, Singapore.
⁵ Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore. Electronic address: surtk@nus.edu.sg.

PMID: 33301736
DOI: 10.1016/j.athoracsur.2020.08.117

Abstract

Background: Although several studies revealed that the Cor-knot automated fastener (LSI Solutions, Victor, NY) reduces aortic cross-clamp and cardiopulmonary bypass times, the influence of the device on postoperative morbidity and mortality still needs to be evaluated. The aim of this study was to verify the hypothesis that the use of the Cor-knot device for heart valve surgery reduces aortic cross-clamp and cardiopulmonary bypass times, and this time saving translates into reduced morbidity and mortality.

Methods: Retrospective cohort studies and randomized controlled trials reporting on the use of the automated fastener vs hand-tied knots were reviewed. The following end points were compared: aortic cross-clamp and cardiopulmonary bypass times, postoperative valvular regurgitation, postoperative ejection fraction, prolonged ventilator support, renal failure, and mortality.

Results: Eight studies reporting data on 942 patients were included in the final analysis. The Cor-knot device was associated with shorter cardiopulmonary bypass (mean difference [MD], -11.74; 95% confidence interval [CI], -14.54 to -8.93; P < .00001) and aortic cross-clamp times (MD, -14.36; 95% CI, -19.63 to -9.09; P < .00001) in minimally invasive heart valve procedures. Overall, lower rates of postoperative valvular regurgitation (risk ratio [RR], 0.40; 95% CI, 0.26 to 0.62; P < .0001) and prolonged ventilator support (RR, 0.29; 95% CI, 0.13 to 0.65; P = .003) were observed. No difference was observed in postoperative atrial fibrillation, ejection fraction, renal failure, and mortality.

Conclusions: The use of the Cor-knot device in heart valve surgery reduced aortic cross-clamp and cardiopulmonary bypass times. Furthermore, as compared with hand-tie methods, the automated fastener may lead to decreased rates of prolonged ventilator support and valvular regurgitation while being noninferior in terms of other postoperative outcomes and mortality.

Publication types

Comparative Study
Meta-Analysis
Systematic Review

MeSH terms

Cardiac Surgical Procedures / methods*
Heart Valves / surgery*
Humans
Suture Techniques / instrumentation*