Automated fastener (Core-Knot) versus manually tied knots in patients undergoing aortic valve replacement: Impact on cross-clamp time and short-term echocardiographic results

The Core-Knot device is an automatic fastener used mainly in minimally invasive heart valve surgery procedures, to facilitate knot tying. The purpose of this report is to compare ischemic time and outcomes of surgical aortic valve replacements (SAVRs) utilizing the Core-Knot device compared with manually tied knots. Between January, 2014 and December, 2016, 119 patients underwent SAVR in Cape Cod Hospital. We compared patient's characteristics, cross-clamp time, and outcomes of 75 patients who underwent SAVR using Core-Knot to those of 44 operated using manually tied knots. Patient characteristics were similar between groups. Patients in the Core-Knot group had higher preoperative aortic valve area and higher ejection fraction. The use of Core-Knot was associated with reduced aortic cross-clamp time (median 70 vs 84 minutes; P < .001). Patients undergoing SAVR using Core-Knot were less likely to have postoperative aortic regurgitation (P < .001). Early mortality, and also the rates of early adverse events (including all cardiac, neurologic, and renal complications), and the immediate postprocedure echo findings were similar in the 2 groups. In multivariate analysis, the use of Core-Knot was associated with reduced postoperative mean gradient across the aortic valve and reduced occurrence of postoperative aortic regurgitation. Older age and larger valve size were other predictors of reduced postoperative mean gradients. The use of an automatic fastener (Core-Knot) in surgical aortic valve replacement cases reduce aortic cross-clamp time and help eliminate postoperative paravalvular aortic regurgitation.