NYMC Faculty Publications
Efficacy of Automated Fasteners Versus Hand-Tied Knots in Cardiac Surgery: a Systematic Review and Meta-Analysis
Author Type(s)
Faculty
DOI
10.17179/excli2023-6885
Journal Title
EXCLI Journal
First Page
198
Last Page
211
Document Type
Review Article
Publication Date
2-6-2024
Department
Surgery
Keywords
automated fasteners; cardiac valvular surgery; COR-KNOT; hand-tied knots
Disciplines
Medicine and Health Sciences
Abstract
Valve surgery is common in cardiac procedures, with fasteners like COR-KNOT® and hand-tied knots used for knot securing. This study compares their efficacy in valve surgery patients. We searched PubMed, SCOPUS, and Cochrane Central until August 2023. Outcomes assessed included aortic cross-clamp time (AXT), cardiopulmonary bypass (CPB) time, valvular regurgitation, mortality, prolonged ventilatory support, atrial fibrillation, postoperative left ventricular ejection fraction (LVEF), and renal failure. Subgroup analysis was performed for minimally invasive and open cardiac surgery. We used a random effects model for analysis. We included eight observational studies and two randomized controlled trials (RCTs) with a total of 1.411 participants. COR-KNOT significantly reduced AXT [MD -15.14, 95 % CI (-18.57, -11.70), P< 0.00001] and CPB time [MD -12.38, 95 % CI (-14.99, -9.77), P< 0.00001]. Valvular regurgitation [RR 0.40, 95 % CI (0.26, 0.61), P< 0.0001] and need for prolonged ventilatory support [RR 0.29, 95 % CI (0.13, 0.65), P=0.003] were significantly lower with COR-KNOT. There were no significant differences in mortality [RR 0.39, 95 % CI (0.09, 1.69), P=0.44], atrial fibrillation [RR 1.03, 95 % CI (0.83, 1.27), P=0.81], LVEF changes [MD 0.05, 95 % CI (-1.37, 1.47), P = 0.95], or renal failure [RR 0.87, 95 % CI (0.16, 4.80), P = 0.87]. COR-KNOT devices reduce operative time and valvular regurgitation without increasing mortality or adverse outcomes. This supports their use in enhancing surgical efficiency and patient outcomes. However, ongoing discussions about suturing techniques, especially in minimally invasive procedures, highlight the need for further research and consensus among practitioners. See also the graphical abstract(Fig. 1).
Recommended Citation
Tharwani, Z. H., Abdul Qadeer, M., Abdullah, A., Ali, R., Chaudhary, M., Qazi, S. U., & Said, S. M. (2024). Efficacy of Automated Fasteners Versus Hand-Tied Knots in Cardiac Surgery: a Systematic Review and Meta-Analysis. EXCLI Journal, 23, 198-211. https://doi.org/10.17179/excli2023-6885
