Automated Versus Conventional Annular Suturing in Totally Endoscopic Aortic Valve and Ascending Aorta Replacement: A Prospective Randomized Trial
- 1University Hospital Bonn, Department of Cardiac Surgery
Abstract
Background Totally endoscopic aortic valve replacement (AVR) combined with ascending aorta replacement (AAR) remains technically demanding, with prolonged CPB and ischemic times. Annular suturing is a principal technical limitation; automated devices aim to simplify this step and improve efficiency. This study compared early clinical outcomes between automated and conventional annular suturing in totally endoscopic AVR with concomitant AAR. Methods Between August 2023 and February 2026, 86 patients undergoing totally endoscopic AVR with concomitant AAR via right anterior minithoracotomy (RAMT) were randomized 1:1 to automated annular (RAM group; n=43) or conventional suturing (conventional group; n=43) in this single-center trial. Primary endpoints were technical success and procedural times; secondary endpoints included complications and 30-day mortality. Results Baseline characteristics were comparable, bicuspid aortic valve morphology was more frequent in the RAM group (74.4% vs. 53.5%; P = 0.043). Automated suturing was associated with shorter median procedure (120.8 vs. 144.0 minutes; P = 0.004), CPB (90.0 vs. 105.0 minutes; P = 0.005), and aortic cross-clamp times (62.0 vs. 74.0 minutes; P = 0.003), respectively. No stroke, conversion to sternotomy, paravalvular leakage, or 30-day mortality occurred in either group. Hospital stay was shorter with automated suturing (6.0 vs. 7.0 days; P = 0.037), while total treatment cost, accounting for incremental device cost, did not differ significantly (P = 0.421). Conclusions Automated annular suturing appears to be a safe, efficient alternative to conventional suturing in totally endoscopic AVR with AAR, associated with reduced operative and ischemic times and shorter hospital stay without compromising early outcomes.
Related
- Individualized Or Conventional Transfusion Strategy During Veno-Arterial Extracorporeal Membrane Oxygenation Support (ICONE Study): Rationale and Design of a Prospective Multicenter Randomized Controlled Trial
- Microbiological surveillance after automated reprocessing of gastrointestinal endoscopes in routine clinical practice: A prospective randomized microbiological surveillance study
- Valve-in-valve transcatheter mitral valve replacement via totally endoscopic endoclamp-assisted approach after failed bioprosthetic mitral valve: a case report.
- Totally endoscopic mitral valve replacement: reasons for non-feasibility of repair and 5-year outcomes
- Safety and Recovery Profile of Propofol-Based Intravenous Sedation for Endoscopic Retrograde Cholangiopancreatography in Adults: A Prospective Single-Center Observational Study
BibTeX
@misc{hamiko2026automated,
title = {{Automated Versus Conventional Annular Suturing in Totally Endoscopic Aortic Valve and Ascending Aorta Replacement: A Prospective Randomized Trial}},
author = {M. Hamiko and J. Rogaczewski and S. Salamate and A. Bayram and F. Piekarski and K. Eghbalzadeh and M. Silaschi and J. Kruse and L. Velicki and M. E. Ibrahim and A. El Sayed Ahmad and F. Bakhtiary},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.27.26366669},
url = {https://www.medrxiv.org/content/10.64898/2026.10.27.26366669v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Automated Versus Conventional Annular Suturing in Totally Endoscopic Aortic Valve and Ascending Aorta Replacement: A Prospective Randomized Trial
AU - M. Hamiko
AU - J. Rogaczewski
AU - S. Salamate
AU - A. Bayram
AU - F. Piekarski
AU - K. Eghbalzadeh
AU - M. Silaschi
AU - J. Kruse
AU - L. Velicki
AU - M. E. Ibrahim
AU - A. El Sayed Ahmad
AU - F. Bakhtiary
PY - 2026
DA - 2026/10/27
PB - medRxiv
DO - 10.64898/2026.10.27.26366669
UR - https://www.medrxiv.org/content/10.64898/2026.10.27.26366669v1
AB - Background Totally endoscopic aortic valve replacement (AVR) combined with ascending aorta replacement (AAR) remains technically demanding, with prolonged CPB and ischemic times. Annular suturing is a principal technical limitation; automated devices aim to simplify this step and improve efficiency. This study compared early clinical outcomes between automated and conventional annular suturing in totally endoscopic AVR with concomitant AAR. Methods Between August 2023 and February 2026, 86 patients undergoing totally endoscopic AVR with concomitant AAR via right anterior minithoracotomy (RAMT) were randomized 1:1 to automated annular (RAM group; n=43) or conventional suturing (conventional group; n=43) in this single-center trial. Primary endpoints were technical success and procedural times; secondary endpoints included complications and 30-day mortality. Results Baseline characteristics were comparable, bicuspid aortic valve morphology was more frequent in the RAM group (74.4% vs. 53.5%; P = 0.043). Automated suturing was associated with shorter median procedure (120.8 vs. 144.0 minutes; P = 0.004), CPB (90.0 vs. 105.0 minutes; P = 0.005), and aortic cross-clamp times (62.0 vs. 74.0 minutes; P = 0.003), respectively. No stroke, conversion to sternotomy, paravalvular leakage, or 30-day mortality occurred in either group. Hospital stay was shorter with automated suturing (6.0 vs. 7.0 days; P = 0.037), while total treatment cost, accounting for incremental device cost, did not differ significantly (P = 0.421). Conclusions Automated annular suturing appears to be a safe, efficient alternative to conventional suturing in totally endoscopic AVR with AAR, associated with reduced operative and ischemic times and shorter hospital stay without compromising early outcomes.
ER -