Comparison of Hand-Tied Suture Versus Titanium Fastener in Structural Cardiac Surgery: A Retrospective Single-Center Analysis

Objective When used to secure prosthetic sutures in valve replacement procedures, titanium fasteners (TFs) have demonstrated benefits in both open and less invasive approaches. This study compares the outcomes from patients whose valve sutures were secured with conventional hand-tied (HT) knots to those whose valve sutures were secured with TFs. Methods A retrospective chart review was conducted to analyze the preoperative baseline characteristics and postoperative outcomes of 200 consecutive patients undergoing surgical valve replacement between January 2020 and May 2023. Patients were grouped according to whether their valve was secured using HT knots or TFs (COR-KNOT MINI ® Device, LSI SOLUTIONS ® , Victor, NY, USA). Results There were no significant differences in baseline preoperative characteristics between the groups. Patients in the TF group had significantly shorter aortic cross-clamp and cardiopulmonary bypass times than patients in the HT group ( P < .05). The TF group also had shorter intensive care unit time and overall hospital length of stay ( P < .05) compared to the HT group. Postoperative bleeding and paravalvular leak were less frequently observed in the TF group than the HT group ( P < .05). Although not statistically significant, there was a trend toward fewer wound infections and lower mortality rates in the TF group. Conclusions In our single center's early experience, the use of TFs in surgical valve replacement was associated with shorter operative times, hospital length of stay, and lower overall complication rate compared to HT valve sutures. These results are consistent with the benefits of TFs that have been previously well established in surgical literature.