Minimally invasive anaortic quadruple and quintuple coronary artery bypass grafting: Feasibility and early outcomes of automated titanium suture fastener - a case series
Danko Grujic, Tatjana Gazibara, Tatjana Kokotovic, Oliver Radmili, Dejan Lazovic, Aleksandar Djordjevic, Vojkan AleksicObjective
To describe the feasibility and early outcomes of automated terminal suture fastening and conventional hand tying during complex anaortic total-arterial minimally invasive coronary artery bypass grafting (MICS-CABG).
Methods
This retrospective, descriptive, single-center surgical case series included 12 patients who underwent elective anaortic off-pump MICS-CABG between January 2024 and May 2025. The first seven patients underwent conventional hand-tied terminal suture securing, whereas the subsequent five underwent automated terminal suture fastening, reflecting the chronological introduction of the device later in the surgeon’s experience. Nine patients underwent quadruple and three underwent quintuple bypass grafting. Clinical follow-up was performed at 30 days and six months after surgery, with CT coronary angiography performed at six months.
Results
All patients were male, with a mean age of 69.4 ± 7.5 years. Mean operating-room time was 373.0 ± 60.1 minutes overall, 384.3 ± 50.0 minutes in the hand-tied group, and 358.0 ± 75.6 minutes in the automated fastener group. No device-related technical failures, incomplete deployments, or device-related anastomotic revisions occurred. No deaths, perioperative myocardial infarctions, strokes, conversions to sternotomy or cardiopulmonary bypass, or repeat revascularizations occurred. Two patients developed pleural effusion, one developed atrial fibrillation, and one patient with pleural effusion required rehospitalization. At six-month CT angiography, all 30 arterial grafts were evaluable; 28 were classified as FitzGibbon grade A, one as grade B, and one as grade O. Both non-grade-A findings occurred in the hand-tied group, whereas all 13 grafts in the automated fastener group were grade A.
Conclusions
In this selected 12-patient, single-surgeon case series, automated terminal suture fastening using COR-KNOT® MICRO was technically achievable during complex anaortic total-arterial MICS-CABG without observed device-related failure. The small sample, chronological device introduction, operator learning curve, and short follow-up preclude conclusions regarding comparative operating-room time, safety, or graft outcomes. Larger prospective studies with anastomosis-specific timing and graft-level follow-up are required.