Key result
The Cor-Knot automated fastener reduced total operation times compared with manual knot-tying in cardiac valve surgery, but lacked evidence for improved clinical outcomes.
Why the study?
The intraoperative benefits of Cor-Knot automated fasteners in cardiac valve surgery are documented, but evidence for improved patient outcomes is lacking.
Does the Cor-Knot automated fastener improve intraoperative efficacy and patient outcomes compared to manual knot-tying in cardiac valve surgery?
Systematic Review
Does the Cor-Knot automated fastener improve intraoperative efficacy and patient outcomes compared to manual knot-tying in cardiac valve surgery?
While the Cor-Knot automated fastener reduces operative time in cardiac valve surgery, it lacks evidence for improved clinical outcomes and adds significant cost.
OBJECTIVE: The Cor-Knot automated fastener has been used to eliminate the need for manual knot-tying in cardiac valve surgery for over a decade. We review the current literature pertaining to Cor-Knot and discuss its benefits and shortcomings with respect to cardiac valve surgery. METHODS: A comprehensive literature search was conducted to identify articles discussing the use of automated fasteners and manually tied knots in the setting of cardiac valve surgery. The search terms used were "heart", "valve surgery", "cardiac", "Cor-Knot", "fastener", "automated fastener", "aortic valve", "mitral valve", "minimally invasive", and "titanium". These terms were used as keywords and, in combination, as MeSH terms to maximize the output of literature searches. Twenty-four relevant articles were identified and reviewed. RESULTS: Current literature provides evidence to support the role of Cor-Knot in facilitating enhanced intraoperative efficacy by reducing total operation times as compared with manual knot-tying. However, studies to date fail to provide evidence for the translation of these intraoperative advantages into improved patient outcomes. Moreover, Cor-Knot is associated with a significant financial burden. CONCLUSION: A plethora of evidence exists to support the intraoperative advantages provided by Cor-Knot. However, the literature is yet to support its role in facilitating superior clinical outcomes as compared with manual knot tying. Larger high-quality trials and studies are required to provide evidence supporting the ongoing use of Cor-Knot in valve surgery.
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Jenkin et al. (2020) conducted a systematic review in cardiac valve surgery. Cor-Knot automated fastener vs. manual knot-tying was evaluated on intraoperative efficacy (total operation times) and patient outcomes. The Cor-Knot automated fastener reduced total operation times compared with manual knot-tying in cardiac valve surgery, but lacked evidence for improved clinical outcomes.
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