Management strategies for loosened knots during cardiac surgery

Suturing and knot-tying during cardiac surgery remain challenging. Unexpectedly loosened knots are particularly stressful and can lead to poor outcomes if not properly handled. Herein, we describe four simple yet practical techniques to address unexpectedly loosened knots or paravalvular leaks caused by them during cardiac surgery. These techniques offer cardiac surgeons alternatives for managing unexpectedly loosened knots and their associated complications. By avoiding reintervention, we believe these techniques are highly beneficial in intraoperative emergencies.