Automated annular suture device versus conventional annular suture technique in endoscopic aortic valve replacement:...

To overcome some of the challenges of endoscopic aortic valve replacement, an automated annular suturing device has been developed and used in aortic valve replacement surgeries. The current study compares the early clinical outcomes of patients who received endoscopic aortic valve replacement with the help of the RAM device (LSI Solutions) versus the conventional annular suture technique.

From March 2017 to March 2025, 1280 patients underwent endoscopic aortic valve replacement via right anterior minithoracotomy in 3 cardiac referral centers in Germany. The RAM automated suture device was used in 259 cases, and the conventional annular suture technique was used in 1021 patients. A propensity score analysis was performed in 259 matched pairs.

The mean age in the matched cohort was 61.87 ± 11.24 years, and mean body mass index was 27.04 ± 4.83 kg/m² across both genders. Mean aortic crossclamping time was significantly lower in the RAM group: 54.67 ± 16.42 minutes versus 62.02 ± 24.72 minutes (P < .001). Mean cardiopulmonary bypass time was also lower in the RAM group (83.75 ± 23.29 minutes vs 97.22 ± 36.45 minutes, P < .001). Reexploration for bleeding occurred more often in the conventional suture group (7.3% without RAM vs 2.3% with RAM (P = .004). There were no significant differences in the incidence of paravalvular leak between groups (RAM 0% vs conventional 0.4%, P = .5).

The use of the RAM device in endoscopic aortic valve replacement is as safe, feasible, and effective as the conventional annular suture technique and yields excellent early outcomes. After a short learning curve, the RAM device was associated with reduced surgical time by facilitating annular suturing in endoscopic fashion.