Titanium Fasteners In Endoscopic Mitral Valve Surgery

Objective We sought to review our experience of new titanium knot fastener devices. We hypothesized that it might reduce the cardiop-polmonary bypass time, aortic cross-clamping time and intervention time. Materials We reviewed our electronic records in order identify the patients who underwent mitral valve (MV) repair and replacement in totally endoscopic setup. Surgical approach was trough limited right periareolar or inframmamary thoracotomy with mainly femoro-femoral arterio-venous cannulation. A part of patients underwent interventions using fast knotting system (FK group, Cor-Knot Device, ISL Solutions Inc) and remaining patients served as control group (conventional hand knotting, HK). We identified the FK patients and performed propensity score matching to match 1:1 ratio from main cohort using FK versus HK. Results A total of 306 patients underwent mitral valve repair or replacement on via right thoracotomy, 265 (87%) patients underwent using FK, remaining. There were on average 2.6 minutes of CPB time reduction (p = 0.64), and 3.1 minutes of CXC time reduction (p = 0.47). However, when dividing into procedures based on complexity, there were on average 8.6 minutes of CPB time reduction (p = 0.18), and 6.9 minutes of CXC time reduction (p = 0.16) in simple cases; on average in complex cases 12 minutes of CPB time was augmented (p = 0.24), and 2.5 minutes of CXC time was augmented(p = 0.76). In propensity matched population the effect of CPB and CXC reduction was consistent and repeated and there were on average 0.5 minutes of CPB time reduction (p = 0.12), and 3.6 minutes of CXC time augmentation (p = 0.05). However, when dividing into procedures based on complexity, there were on average 0.2 minutes of CPB time reduction (p = 0.16), and 2.7 minutes of CXC time augmentation (p = 0.06) in simple cases; on average 5 minutes of CPB time augmentation (p = 0.34), and 14.2 minutes of CXC time augmentation (p = 0.58) in complex cases. Conclusions Titanium fasteners are useful tool to have in minimally invasive approaches, especially in complex cases and redo interventions. Titanium are comfortable and fast in many cases then conventional knot tying, but it is also expensive the traditional knotting. The titanium fasteners do not offer significant time reduction. In matched group the pattern of time saving were identical to main cohort.