The Use Of Cor-knot Device Decrease The Incidence Of Paravalvular Leak During Aortic Valve Replacement
Konstadinos Plestis1, Bailey Sparks2, Cinthia Orlov1, Oleg Orlov1, Matthew Thomas3, Roberto Rodriguez1, Scott Goldman1.
1Lankenau Medical Center, Philadelphia, PA, USA, 2Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA, 3lankenau medical center, Philadelphia, PA, USA.
OBJECTIVE: Paravalvular leak(PVL) is a serious complication after aortic valve replacement(AVR). We evaluated the impact of utilizing the Cor-Knot automated suture fastening system on the incidence of PVL in isolated AVR procedures.
METHODS: This is a retrospective review of prospectively collected data from all patients who underwent isolated AVR between 2006 and 2016. In one group, Cor-Knot was used to secure the sutures(CK-Group, n=331), while in the other the knots were hand tied(HT-Group, n=321).
RESULTS: There were 208(62.9%) males (mean age: 71.5±9.9) in the CK group, and 171(53.3%) males (mean age: 73.2±9.9) in the HT-group. Partial sternotomy AVR (MIAVR) was performed in 261(78.8%) patients in the CK-group and in 158(49.2%) patients in HT-group (p<0.001). Aortic stenosis was present in 312(94.2%)vs.301(93.7%) patients(p=0.206), hypertension in 278(84%)vs.245(76.3%) patients(p=0.014), diabetes 89(26.9%)vs. 73(22.7%) patients (p=0.221), hypercholesterolemia 262(79.1%)vs.231(71.9%) patients(p=0.033) in the CK vs. the HT groups respectively. The mean cross clamp time was 84.7±21.6 vs. 87.6±22.7 minutes (p=0.026), and the mean pump time was 111.1±27.9 vs.111±28.5 minutes (p=0.948) for the CK and HT groups respectively. The mortality, stroke, new onset renal insufficiency and atrial fibrillation were 6(1.9%),2(0.6%),12(3.6%),103(31%)vs.7(2.2%), 9(2.8%),14(4.3%),95(29.6%) for the CK and HT group respectively (p>0.05). The average intubation time was 0.8±1.9vs.0.8 ±2.6 days (p=0.916), the ICU stay was 4.4±6.5 vs.4.5±7.3 days (p=0.876) and the hospital stay was 7.4±6.7 vs. 8.5±7.7 days (p=0.007) for the CK and HT group respectively. The total number of significant PVLs was 14. There were 3(0.9%) PVL (2 mild and 1 moderate) in the CK-Group and 11(3.4%) (7 mild, 2 moderate and 2 severe) in the HT-Group (p=0.013). In the MIAVR group there were 10 PVLs. In the CK-MIAVR group (n=261) there were 3(1.2%) (2 mild and 1 moderate) PVLs and in the HT-MIAVR (n=163) group there were 7(4.4%) PVLs (4 mild, 2 moderate and 1 severe) (p=0.017). There was no statistically significant difference in the PVLs (0 vs 4, p=0.091) between the CK group and the HT group in the full sternotomy AVRs.
CONCLUSIONS: The utilization of the Cor-Knot device significantly decreases the incidence of PVL, particularly in minimally invasive approach, thus decreasing the possibility of early and late reintervention.
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