# Automated Suture Securing Technology in Mitral Valve Surgery: A Strategy to Reduce Prosthetic Dehiscence?

## TL;DR

This study compares automated titanium fasteners to hand-tied knots in mitral valve surgery and finds fewer prosthetic dehiscence cases with the automated method.

## Contribution

The study introduces a novel suture-securing technique using automated titanium fasteners in mitral valve surgery.

## Key findings

- Automated titanium fasteners were associated with a significantly lower risk of prosthetic dehiscence.
- No increased risk of ischaemic stroke, intracranial bleeding, or mortality was observed with the automated method.
- The results suggest potential benefits of automated fasteners but caution is advised due to limited events and possible confounding.

## Abstract

This study aimed to assess long-term outcomes of automated titanium fasteners versus hand-tied knots in mitral valve surgery.

In this retrospective, single-centre analysis, 2678 adult patients who underwent mitral valve repair or replacement between November 2008 and November 2024 at the Medical University of Vienna were included. Patients were grouped according to the suture-securing technique used: automated titanium fasteners versus hand-tied knots. The primary endpoint was prosthetic dehiscence (either mitral annuloplasty ring or valve replacement prosthesis) requiring reintervention. Secondary endpoints comprised ischaemic stroke, intracranial bleeding, and all-cause mortality during the follow-up period.

Among the study population, 1072 (40%) underwent mitral valve surgery using an automated titanium fastener device, and 1606 (60%) with conventional hand-tied sutures. A total of 31 patients (1.2%) had prosthetic dehiscence during the follow-up period. The risk of prosthetic dehiscence was significantly lower in the automated titanium fastener group in both univariable (crude sub-hazard ratio [sHR] 0.32; 95% confidence interval [CI], 0.12-0.86, P = .023) and multivariable competing risk regression analysis (adjusted sHR 0.34; 95% CI, 0.12-0.91, P = .033). Automated titanium fastener group was not associated with an increased risk of ischaemic stroke (adjusted sHR 0.92; 95% CI, 0.67-1.27, P = .600), intracranial bleeding (adjusted sHR 0.89; 95% CI, 0.52-1.52, P = .675), or all-cause mortality (adjusted hazard ratio 0.93; 95% CI, 0.74-1.18, P = .559).

The use of an automated titanium fastener device seems to be associated with a lower risk of prosthetic dehiscence in mitral valve surgery. Due to the limited number of prosthetic dehiscence events and the potential for residual confounding, the results should be interpreted with caution.

In mitral valve surgery, the annuloplasty ring and valve replacement prosthesis are traditionally anchored using hand-tied sutures.