Cor-Knot Use in SAVR Facilitates Coplanar Angle Adjustment During TAVR

Keywords: automated suture fastener, coplanar angle, renal failure, transcatheter aortic valve replacement, valve-in-valve

The Cor-Knot surgical tying device (LSI Solutions) is an automated suture fastener with a titanium-crimpable sleeve that facilitates a fast and secure knot. The device is an alternative to hand tying, with minimizing operation time and its increasing use is anticipated for minimally invasive cardiac surgeries or in patients with small surgical anatomy. As its use expands, the likelihood of encountering this knotting device during structural interventions may increase.

An 84-year-old female presented with symptomatic severe aortic stenosis (mean pressure gradient, 96 mm Hg) secondary to failure of a 21-mm Trifecta aortic valve bioprosthesis (St Jude Medical), which was implanted in 2015 at a local hospital. She has chronic renal failure, with estimated glomerular filtration rate of 31 mL/min/m². After a multidisciplinary team discussion, we decided to perform valve-in-valve transcatheter aortic valve replacement (TAVR) with a 23-mm Evolut Pro Plus valve (Medtronic). Preoperative computed tomography (CT) scan identified Cor-Knots in her aortic annulus.

During the TAVR procedure, coplanar angle estimated from preoperative CT scan was easily adjusted referencing the line of Cor-Knot in her aortic annulus without administrating contrast although poor radiodensity from the Trifecta valve. In the coplanar view, the TAVR valve depth was well appreciated in reference to the Cor-Knot line and the TAVR valve was deployed under controlled pacing without contrast use (Figure 1 and Figure 2). We achieved mean aortic pressure gradient of 9 mm Hg without perivalvular leakage or conduction abnormalities. She was discharged to home the next day without renal injury.

From ¹Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and the ²School of Medicine, Case Western Reserve University, Cleveland, Ohio.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted May 27, 2022.

Address for correspondence: Makoto Hibino, MD, MPH, PhD, Division of Cardiac Surgery, Lakeside 3rd Floor, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106. Email: mhibino-ngy@umin.org