Key result
Cor-Knot automated fastener use during MICS-AVR causes delayed leaflet perforation requiring reoperation.
Case Report (n=1)
The use of automated knot fasteners like Cor-Knot in narrow anatomic spaces during MICS-AVR requires perpendicular apposition to the sewing ring to prevent catastrophic prosthetic leaflet perforation.
Cor-Knot use in narrow MICS-AVR annuli may risk leaflet perforation; leaves open optimal placement techniques for bicuspid anatomies.
A 38-year-old woman underwent minimally invasive aortic valve replacement with a 21-mm Inspiris aortic valve and Cor-Knot for type 0 bicuspid valve and severe aortic stenosis. Postoperative transthoracic echocardiography was uneventful. Four months later, she experienced shortness of breath. Transthoracic echocardiography revealed moderate to severe aortic valve regurgitation, and prosthetic valve dysfunction was suspected. Aortic valve reoperation through a median sternotomy was performed. The bioprosthetic valve was perforated at the noncoronary cusp valve site, probably because of prolonged exposure to the Cor-Knot. When Cor-Knot is used in a narrow space, a perpendicular apposition should always be maintained between the sewing ring and the Cor-Knot tips.
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Kawamura et al. (2024) conducted a case report in Severe aortic valve stenosis with type 0 bicuspid valve (n=1). Cor-Knot automated fastener during MICS-AVR was evaluated. The use of a Cor-Knot automated fastener during minimally invasive aortic valve replacement for a type 0 bicuspid valve resulted in delayed leaflet perforation and severe regurgitation requiring reoperation.
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