JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
DISCUSSION
As the use of minimally invasive procedures (aortic and mitral) continues to rise exponentially, so will new technological advances aimed at making these procedures safer for the patient and technically easier for the physician. With new technology and procedures, new pitfalls and potential complications will inevitably arise. Minimally invasive valve sutures can be tied either manually, through a knot pusher, or through an automated device such as the COR-KNOT. The COR-KNOT is an automated device intended to eliminate one of the major drawbacks to MIAVR, the need for remote knot-tying to secure the valve. Researchhas shown that sutures tiedusing theCOR-KNOT device are generally stronger and more resistant to tensile forces than a manually tied knot. 3,4 The COR-KNOT device is also faster than manual hand tying, thereby reducing cardiopulmonary bypass and total operation time, which is associated with decreased blood loss, shorter hospital stays, and lower in-hospital mortality rates. 5 Despite the benefits the COR-KNOT provides, surgeons must be aware of the possibility of mechanical failure of the sutures and the potential life-threating side effects. We hope by reading about our experience with identifying and treating such a complication, surgeons will keep this rare potential event in the differential of patients with intraoperative hemodynamic collapse. To the best of our knowledge, this report is the first of its kind and will broaden understanding of the clinical diagnosis of this type of case.
REFERENCES
1. Ahangar AG, CharagAH,Wani ML, et al. Comparing aortic valve replacement through right anterolateral thoacotomy with median sternotomy. Int Cardiovasc Res J 2013;7:90.94. 2. Gilmanov D, Solinas M, Farneti PA, et al. Minimally invasive aortic valve replacement: 12-year single center experience. Ann Cardiothorac Surgery 2015;4:160.169. 3. Gersak BM, Sauer JS. In vitro testing of titanium know fastener used in cardiac and general surgery with pull apart force. J Cardiothorac Surg 2013;8:64. 4. Lee CY, Sauer JS, Gorea HR, et al. Comparison of Strength, consistency, and speed of COR-KNOT versus manually Hand-tied knots in an ex vivo minimally invasive model. Innovations 2014;9:111.116. 5. Chalmers J, Pullan M, Mediratta N, et al. A need for speed? Bypass time and outcomes after isolated aortic valve replacement surgery. Interact Cardiovasc Thorac Surg 2014;9:21.26.
Alexandrea E. Tedesco is a medical student at Louisiana State University Health Sciences Center in New Orleans, LA. Dr. Tedesco IV, MD , is a cardiothoracic surgeon practicing at Lafayette General Medical Center, Department of Cardiovascular and Thoracic Surgery, in Lafayette, LA.
J La State Med Soc VOL 169 JULY/AUGUST 2017 95
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