Jenkin Ifan, Prachee Ishika, Sokal Pawel Aleksander, Harky Amer
Medical Sciences Division, University of Oxford, Oxford, UK.
Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK.
J Card Surg. 2020 Nov;35(11):2987-2994. doi: 10.1111/jocs.14953. Epub 2020 Aug 16.
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.
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.
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.
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.
Cor-Knot自动缝合器已在心脏瓣膜手术中用于消除手工打结操作，至今已有十多年。我们回顾了目前与Cor-Knot相关的文献，并讨论其在心脏瓣膜手术中的优缺点。
进行了全面的文献检索，以确定讨论在心脏瓣膜手术中使用自动缝合器和手工打结的文章。使用的检索词为“心脏”“瓣膜手术”“心脏的”“Cor-Knot”“缝合器”“自动缝合器”“主动脉瓣”“二尖瓣”“微创”和“钛”。这些词用作关键词，并组合用作医学主题词，以最大限度地提高文献检索的输出。共识别并回顾了24篇相关文章。
当前文献提供了证据，支持Cor-Knot与手工打结相比，通过减少总手术时间来提高术中效率。然而，迄今为止的研究未能提供证据表明这些术中优势能转化为改善患者预后。此外，Cor-Knot会带来巨大的经济负担。
有大量证据支持Cor-Knot所具有的术中优势。然而，与手工打结相比，目前文献尚不能支持其在促进卓越临床结局方面的作用。需要更大规模的高质量试验和研究来提供证据，支持在瓣膜手术中继续使用Cor-Knot。
