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Automated Suture Fastener Gaining Complete Commitment: Cumulative Propensity-Matched Comparison with Hand-Tied Knot
Ashlynn Ler1,2, Duoduo Wu1,3, Ong Zhi Xian1,3
1162643 Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.
Insights
The COR-KNOT® device, an automated suture fastener, significantly reduced cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times in heart valve surgery. Clinical outcomes were not adversely affected by its use.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Surgical Technology
Background:
- The role of automated suture fasteners like COR-KNOT® in heart valve surgery lacks established consensus.
- Evaluating novel devices is crucial for optimizing surgical procedures and patient outcomes.
Purpose of the Study:
- To compare clinical outcomes of the COR-KNOT® automated suture fastener against traditional hand-tied sutures in heart valve surgery.
- To assess the impact of COR-KNOT® on operative times and patient safety.
Main Methods:
- A single-center, retrospective cohort study was conducted from January 2015 to February 2020.
- Propensity score matching created comparable groups of 124 patients each, utilizing COR-KNOT® versus hand-tied sutures.
- Clinical outcomes, operative details, and baseline demographics were analyzed.
Main Results:
- Use of COR-KNOT® was associated with significant reductions in cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times across different surgical subgroups.
- Specifically, in median sternotomy procedures, CPB time decreased by approximately 49 minutes and ACC time by 32 minutes.
- In the valve and CABG subgroup, COR-KNOT® use led to a 70-minute reduction in overall operation time.
Conclusions:
- The COR-KNOT® automated suture fastener is associated with decreased CPB and ACC times in heart valve surgery.
- The study suggests that the use of COR-KNOT® does not negatively impact clinical outcomes.
- Automated suture technology offers potential benefits in reducing operative duration during cardiac valve procedures.
Objective:
The COR-KNOT® device is an automated suture fastener in which there is currently no consensus on its role in heart valve surgery. Our aim was thus to conduct a one-to-one comparison of clinical outcomes with a hand-tied control cohort.
Methods:
We performed a single-center, cumulative propensity-matched retrospective cohort study on patients undergoing heart valve surgery from 1 January 2015 to 13 February 2020. Propensity score matching was performed on 693 patients, dividing them into matched COR-KNOT® (n = 124) and hand-tied (n = 124) groups.
Results:
Data on baseline demographics, operative details, and clinical outcomes were analyzed and compared between the groups. The patients in both the COR-KNOT® and control groups were well-matched. For the median sternotomy (MS) all procedures subgroup, use of COR-KNOT® was associated with a decrease of around 49 min in CPB time (220.00 [168.00 to 256.00] vs 70.50 [134.00 to 236.75] min, P = 0.006) and around 32 min in ACC time (145.00 [109.00 to 189.00] vs 112.50 [81.00 to 161.75] min, P = 0.008). In the MS valve and CABG subgroup, use of COR-KNOT® was associated with a 70 min reduction in overall operation time (401.00 [354.25 to 468.75] vs 330.50 [288.50 to 370.50] min, P = 0.013), 63 min reduction in CPB time (216.50 [191.75 to 283.25] vs 153.00 [124.75 to 207.50] min, P = 0.004) and 45 min reduction in ACC time (146.00 [134.50 to 205.50] vs 100.50 [71.50 to 150.75] min, P = 0.003).
Conclusions:
In heart valve surgery, use of the automated suture fastener was associated with shorter CPB and ACC times. Additionally, we determined that clinical outcomes are most likely unaffected by the use of COR-KNOT®.
