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Comparison of corknot device suture-fastening system versus hand tying in conventional open cardiac surgery: A retrospective study
Sudeep Das De, Paschalis Kapsomenakis, Susan Dewar, Hussein El-Shafei.
Aberdeen Royal Infirmary, Aberdeen UK, United Kingdom.

OBJECTIVE: The corknot device is an automated suture-fastening system, which enables the operator to secure the knot, trim and cut the suture without the need for hand tying and cutting the sutures. The corknot device is used mainly in minimally invasive valve surgery to facilitate easier access and remote suture tensioning.In this study, our aims were to evaluate the safety and speed of the corknot device compared to hand tying in conventional open surgery.
METHODS: Retrospective study on patients who underwent cardiac surgery by a single surgeon in one centre between October 2013 and June 2014. Procedures included conventional aortic valve replacement with or without concomitant CABG and major aortic surgery. The cohort of patients was divided into 2 groups based on the suturing technique used; the corknot device was used in patients between December 2014 and June 2015. The outcomes were compared to a historical control of patients between October 2013 and December 2014 where conventional hand tying and cutting with scissors was used.The primary outcome measure in each group was the cross clamp time. We performed multivariate linear regression analyses to compare differences in means of cross clamp times between the 2 groups.
RESULTS: In the analysis of the entire cohort, the mean cross clamp time in the hand tying group was 15.6 minutes longer compared to the corknot group (95% CI 8.6-22.6, P<0.05).In the subgroup of patients who underwent isolated aortic valve surgery, the mean cross clamp time was 15.96 minutes longer in the hand tying group compared to the corknot group after adjustment (95% C.I. 7.55-24.37, P <0.05).The mean cross clamp time in patients who underwent aortic valve replacement and concomitant CABG using hand tying was 15.5minutes longer compared to the corknot group (95% CI 5.85-25.1, P<0.05).
CONCLUSIONS: Our study has demonstrated that the corknot device is a safe suture-fastening system and reduces the cross-clamp times significantly in conventional surgery. Larger randomized controlled trials with longer follow-up times are necessary to further evaluate the safety and efficacy of this device compared to conventional hand tying, especially in the context of concomitant aortic and multiple valve procedures.

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