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

Abstract

BACKGROUND: While several studies revealed that the Cor-knot automated fastener reduces aortic cross-clamp and cardiopulmonary bypass times, the influence of the device on postoperative morbidity and mortality still needs to be evaluated. Our aim 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 which translate 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 endpoints 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 into the final analysis. The Cor-knot device was associated with shorter cardiopulmonary bypass (MD:-11.74, 95% CI:-14.54 to -8.93, p<0.00001) and aortic cross-clamp times (MD:-14.36, 95% CI:-19.63 to -9.09, p<0.00001) in minimally invasive heart valve procedures. Overall, a lower rate of postoperative valvular regurgitation (RR: 0.40, 95% CI:0.26 to 0.62, p<0.0001) and prolonged ventilator support (RR: 0.29, 95% CI:0.13 to 0.65, p=0.003) 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 to hand-tie methods, the automated fastener may lead to decreased rates of prolonged ventilator support and valvular regurgitation, while being non-inferior in terms of other postoperative outcomes and mortality.