Automated Versus Conventional Annular Suturing in Totally Endoscopic Aortic Valve and Ascending Aorta Replacement: A Prospective Randomized Trial

Automated annular suturing during totally endoscopic aortic valve replacement with concomitant ascending aorta replacement shortened median procedure time to 120.8 minutes versus 144.0.

• Why it matters: Totally endoscopic AVR plus ascending aorta replacement is technically demanding, and annular suturing contributes to prolonged CPB and ischemic times.
• What they did: In a single-center randomized trial (n=86) from August 2023 to February 2026, patients were assigned 1:1 to automated annular suturing (RAM group, n=43) or conventional suturing (n=43), with technical success and procedural times as primary endpoints.
• The result: Automated suturing also reduced CPB (90.0 vs. 105.0 minutes) and cross-clamp time (62.0 vs. 74.0 minutes), shortened hospital stay (6.0 vs. 7.0 days), and showed no stroke, sternotomy conversion, paravalvular leakage, or 30-day mortality in either group.

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