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Significant Reduction in Operative Times Using Cor-Knot™ In Robot-Assisted Mitral Valve Repair
L. Wiley Nifong, Hazaim Alwair, Douglas Parker, Dhagash Patel, W. Randolph Chitwood, Jr..
East Carolina Heart Institute, Greenville, NC, USA.

Significant Reduction in Operative Times Using Cor-Knot™
In Robot-Assisted Mitral Valve Repair
Introduction: A substantial barrier to widespread adoption of robot-assisted mitral valve repair surgery (RAMVP) is increased operative time when compared with median sternotomy operations. The Cor-Knot™ device (LSI Solutions, Inc., Victor, NY) uses a titanium clip to secure sutures, eliminating intra-cardiac knot tying and reducing operative times.
Methods: In this review of our retrospective RAMVP operative data, we compare total times for either Cor-Knot™ delivery or robotic suture tying, as well as annuloplasty band placement (ABP), cardiopulmonary bypass (CPB), and aortic cross-clamping (XC). Patients in whom Cor-Knot™ was used (N=48) were compared with those where robotic suture tying was used (n=288). Comparisons between groups were analyzed using two-tailed Student’s t-test.
Results: Between May 2000 and December 2012, 800 patients underwent RAMVP at our institution. The mean age was 59.7±12.1 years (mean ± SD) for those studied. Operative results are summarized in Table 1. All differences were significant, p<0.02. The mean Cor-Knot™ device time for annuloplasty deployment was significantly shorter when compared with robotic knot tying. Furthermore ABP, CPB, and XC times also were significantly shorter in the Cor-Knot™ cohort.
Conclusions: When compared to intra-cardiac robotic suture tying for RAMVP, the Cor-Knot™ device shortens all operative times significantly. The mean annuloplasty band placement time was reduced by 10 minutes. Moreover, CPB and XC times were significantly shorter in the Cor-Knot™ cohort. A randomized study is required to confirm these findings.
Table 1.
VariableCore KnotRobotic Tying
Robotic ProceduresN=48N=288
Sutures Placed4883161
Securing Suture (seconds)48.6±24.6*72.6±36.0
Suture Placement and Securing Suture (seconds)107.4±50.4*151.8±71.4
ABP time (minutes)26.9±7.4*36.6±10.2
CPB time (minutes)144.9±30.1*160.3±40.1
XC time (minutes)94.7±31.1*123.0±33.3

*Indicates a statistical significance, p<0.02


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