Jhala Hiral, Buchan Keith, El-Shafei Hussein
Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, UK, AB25 2ZN, United Kingdom.
J Cardiothorac Surg. 2025 Aug 6;20(1):323. doi: 10.1186/s13019-025-03419-5.
In the era of minimally invasive valve surgery (MIVS), automated titanium fasteners such as Cor Knot®, have reduced aortic-cross clamp (AXC) and cardiopulmonary bypass (CPB) times to improve survival outcomes. Whilst, most comparative studies pertain to MIVS, there is a lack of literature comparing Cor-Knot (CT) and manual knot tying (MT) in open valve procedures performed via full median sternotomy, particularly the long-term outcomes. We primarily compare AXC and CPB times, residual valvular regurgitation (RVR), freedom from valve re-intervention (FFI) and secondary post-operative outcomes of CT vs MT.
Retrospective analysis was performed for all adult patients, undergoing any first-time or redo valve surgery ± concomitant procedure via full median sternotomy, at a single-centre between January 2017 and January 2024). Patients were grouped according to operation type: isolated aortic valve replacement (AVR), isolated mitral valve replacement (MVR), isolated mitral valve repair (MVr), double valve, valve and concomitant CABG, major aortic surgery and redo valve surgery. Patients within each procedural group were further subdivided into either CT or MT groups. RVR and FFT between CT and MT in each subgroup were analysed using the Kaplan-Meier method.
N = 1010 (CT: N = 492, MT: N = 518). Mean age was 67.7 years. AXC and CPB times were lower in the CT group (62.9 and 86.4 min) vs the MT group (74.9 and 100.1 min) in isolated aortic valve replacements (AVR)(p < 0.001). AXC and CPB times were also lower in the CT group (83.6 and 120.9 min) vs the MT group (103.7 and 143.3 min) in valve + CABG procedures (p < 0.001). The CT group had no RVR in isolated AVR or valve & CABG procedures, however a higher RVR in mitral valve surgery (p = 0.28), double valves (p = 0.49) and redo valves (p > 0.99) compared to the MT group. FFI at 7 years was 98.8% (MT) vs 94.1% (CT) (p = 0.02) in isolated AVR.
Cor-knot can safely and easily be used in all valve procedures. Intra-operative and cinical outcomes with CorKnot can be correlated better in AVR however the short and long-term benefits of CorKnot following mitral surgery are limited. Further larger studies, particularly in more complex procedural groups and long-term analyses are warranted to further validate our results.
在微创瓣膜手术（MIVS）时代，诸如Cor Knot®等自动化钛制紧固件减少了主动脉阻断钳（AXC）和体外循环（CPB）时间，从而改善了生存结果。虽然大多数比较研究涉及MIVS，但缺乏关于在经全胸骨正中切开术进行的开放瓣膜手术中比较Cor-Knot（CT）和手工打结（MT）的文献，尤其是长期结果。我们主要比较CT与MT的AXC和CPB时间、残余瓣膜反流（RVR）、免于瓣膜再次干预（FFI）以及术后次要结果。
对2017年1月至2024年1月期间在单中心接受任何首次或再次瓣膜手术±同期手术且经全胸骨正中切开术的所有成年患者进行回顾性分析。患者根据手术类型分组：孤立性主动脉瓣置换术（AVR）、孤立性二尖瓣置换术（MVR）、孤立性二尖瓣修复术（MVr）、双瓣膜手术、瓣膜手术同期冠状动脉旁路移植术（CABG）、主动脉大手术和再次瓣膜手术。每个手术组内的患者进一步细分为CT组或MT组。使用Kaplan-Meier方法分析每个亚组中CT和MT之间的RVR和FFT。
N = 1010（CT组：N = 492，MT组：N = 518）。平均年龄为67.7岁。在孤立性主动脉瓣置换术（AVR）中，CT组的AXC和CPB时间（分别为62.9分钟和86.4分钟）低于MT组（分别为74.9分钟和100.1分钟）（p < 0.001）。在瓣膜 + CABG手术中，CT组的AXC和CPB时间（分别为83.6分钟和120.9分钟）也低于MT组（分别为103.7分钟和143.3分钟）（p < 0.001）。在孤立性AVR或瓣膜与CABG手术中，CT组无RVR，但与MT组相比，在二尖瓣手术（p = 0.28）、双瓣膜手术（p = 0.49）和再次瓣膜手术（p > 0.99）中有更高的RVR。在孤立性AVR中，7年时的FFI为98.8%（MT）对94.1%（CT）（p = 0.02）。
Cor-knot可安全、简便地用于所有瓣膜手术。在AVR中，CorKnot的术中及临床结果相关性更好，但二尖瓣手术后CorKnot的短期和长期益处有限。需要进一步开展更大规模的研究，尤其是在更复杂的手术组中，并进行长期分析以进一步验证我们的结果。
