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What is the safety and efficacy of the use of automated fastener in heart valve surgery?
Author(s) -
Salmasi M. Yousuf,
Chien Lueh,
Hartley Philip,
AlBalah Amer,
Lall Kulvinder,
Oo Aung,
Casula Roberto,
Athanasiou Thanos
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14265
Subject(s) - medicine , surgery , cardiac surgery , cardiopulmonary bypass , intensive care unit , mitral valve , confidence interval , cardiology
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.