Using Cor-Knot Device in Cardiac Surgery
Overview
The Cor-Knot device, developed by LSI Solutions, is an innovative tool designed to replace traditional hand-tied surgical knots in cardiac valve surgery. This single-use device is employed in procedures such as mitral valve repair and aortic valve replacement, both open and minimally invasive. By streamlining the knot-tying process, Cor-Knot aims to enhance surgical efficiency and patient outcomes.
Technology and Components
The Cor-Knot device consists of a handle, lever, and shaft, available in two sizes:
- Cor-Knot MIS: 31 cm length, 5 mm diameter shaft.
- Cor-Knot Mini: 17 cm length, 4 mm diameter shaft, with an additional rotational knob and indicator fin for better suture orientation.
The system also includes a quick load unit for loading a sterile titanium fastener (Cor-Knot fastener) into the device. When the applicator lever is squeezed, it secures the suture by crimping the fastener and simultaneously trims the suture tails. While designed for LSI 2-0 polyester sutures, the device is compatible with other 2-0 polyester sutures.
Benefits of the Cor-Knot System
Speed and Consistency
Provides quicker, more consistent, and secure knots compared to hand-tied methods. Reduces operative times, including cardiopulmonary bypass time and aortic cross-clamp time.
Enhanced Suture Fixation
Ensures uniform fixation force across all suture points, offering greater reliability than traditional knots. Facilitates suture fixation, particularly in minimally invasive procedures where precision is crucial.
Clinical Efficiency
Decreases the risk of paravalvular leaks, improving overall surgical outcomes. Its use is expected to increase in minimally invasive surgeries and patients with small surgical anatomy.
Current Care Pathway
For patients with severe aortic valve dysfunction, the standard treatment involves aortic valve replacement using an artificial prosthesis (biological or mechanical). This can be achieved through:
- Open Heart Surgery
- Transcatheter Aortic Valve Implantation (TAVI): A less invasive method avoiding sternotomy and cardiopulmonary bypass.
In cases where Cor-Knot is utilized, the device significantly enhances intraoperative efficacy by reducing total operation times compared to manual knot-tying. However, while the device offers clear intraoperative advantages, further studies are required to confirm its impact on long-term patient outcomes.
Regulatory Approvals and Adoption
The Cor-Knot system has received CE mark certification for Europe and FDA approval for use in the United States. Since 2009, it has been adopted in more than 90% of minimally invasive cardiac surgery centers in the U.S.
Conclusion
The Cor-Knot device represents a significant advancement in cardiac valve surgery, offering improved efficiency and safety. By reducing surgery times and minimizing complications, Cor-Knot supports better patient outcomes and represents a valuable tool in modern cardiac surgery.
Key Points for Surgical Technologists
- Preparation: Ensure compatibility of sutures with the Cor-Knot system.
- Operation: Familiarize with the device's handle, lever, and quick load unit for optimal use (SEE VIDEO).
- Procedure: The rapid delivery system may make it challenging to keep up with proper needle handling and counting. Therefore, having a strategy, such as assigning another technician to help during this part of the procedure or using a receptacle to hold all needles from the valve suture and Cor-Knot securely, is crucial for proper handling and counting after the process is completed.
