Key result
Automated annular suturing cuts procedure time by ~23 minutes vs conventional suturing in endoscopic AVR.
Why the study?
Totally endoscopic AVR combined with AAR is technically demanding with prolonged CPB and ischemic times, and annular suturing is a principal technical limitation. Automated devices aim to simplify this step, motivating a comparison of early clinical outcomes between automated and conventional annular suturing.
Does automated annular suturing improve technical success and reduce procedural times compared to conventional suturing in patients undergoing totally endoscopic aortic valve replacement with concomitant ascending aorta replacement?
RCT (n=86)
1:1
No
Does automated annular suturing improve technical success and reduce procedural times compared to conventional suturing in patients undergoing totally endoscopic aortic valve replacement with concomitant ascending aorta replacement?
In totally endoscopic aortic valve and ascending aorta replacement, automated annular suturing significantly reduces operative, cardiopulmonary bypass, and cross-clamp times as well as hospital stay compared to conventional suturing, without increasing total treatment costs or compromising early clinical safety.
Answers are grounded in this paper and cite their sources.
May shorten operative times and hospital stay in endoscopic aortic surgery; leaves open generalizability beyond this single-center trial.
Background Totally endoscopic aortic valve replacement (AVR) combined with ascending aorta replacement (AAR) remains technically demanding, with prolonged CPB and ischemic times. Annular suturing is a principal technical limitation; automated devices aim to simplify this step and improve efficiency. This study compared early clinical outcomes between automated and conventional annular suturing in totally endoscopic AVR with concomitant AAR. Methods Between August 2023 and February 2026, 86 patients undergoing totally endoscopic AVR with concomitant AAR via right anterior minithoracotomy (RAMT) were randomized 1:1 to automated annular (RAM group; n=43) or conventional suturing (conventional group; n=43) in this single-center trial. Primary endpoints were technical success and procedural times; secondary endpoints included complications and 30-day mortality. Results Baseline characteristics were comparable, bicuspid aortic valve morphology was more frequent in the RAM group (74.4% vs. 53.5%; P = 0.043). Automated suturing was associated with shorter median procedure (120.8 vs. 144.0 minutes; P = 0.004), CPB (90.0 vs. 105.0 minutes; P = 0.005), and aortic cross-clamp times (62.0 vs. 74.0 minutes; P = 0.003), respectively. No stroke, conversion to sternotomy, paravalvular leakage, or 30-day mortality occurred in either group. Hospital stay was shorter with automated suturing (6.0 vs. 7.0 days; P = 0.037), while total treatment cost, accounting for incremental device cost, did not differ significantly (P = 0.421). Conclusions Automated annular suturing appears to be a safe, efficient alternative to conventional suturing in totally endoscopic AVR with AAR, associated with reduced operative and ischemic times and shorter hospital stay without compromising early outcomes.
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Hamiko et al. (2026) conducted an RCT in Aortic valve and ascending aorta disease requiring totally endoscopic replacement (n=86). Automated annular suturing (RAM) vs. Conventional annular suturing was evaluated on Technical success and procedural times (procedure, cardiopulmonary bypass, and aortic cross-clamp times) (p=0.004). Automated annular suturing reduced median procedure (120.8 vs 144.0 min; P=0.004) and cross-clamp times (62.0 vs 74.0 min; P=0.003) compared with conventional suturing in endoscopic AVR with AAR.
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