Valvular Regurgitation After Implantation Of Prostheses Secured With Cor-Knot Automated Fasteners

An extremely important journal article comprised of two case reports involving valve perforation and insufficiency following use of the Cor-Knot Automated Fastener (LSI Solutions, Victor, NY, USA) during valve replacement.  Injuries to the leaflets of either a native or prosthetic valve after valve repair or replacement, respectively, consisted of perforations.  These perforations corresponded precisely to areas where the valve leaflets would likely abrade against the metallic fasteners of the Cor-Knot.   The most likely mechanisms leading to this complication include a non-parallel orientation of the fasteners with respect to the valve annulus and the use of an intra-annular valve replacement technique during AVR. To prevent this complication, the authors suggest that surgeons should be meticulous about orienting the fasteners parallel to the valve annulus and should consider revising their AVR technique to positioning the prosthetic valve in a supra-annular rather than annular position when using the Cor-Knot device.
Comment:  Of note, this is a rare complication with the Cor-Knot device, but can easily be prevented by following the suggestions of the authors.