Delayed Metallic Embolization of a Cor-Knot Fastener

Garrett, H. Edward

doi:10.1055/s-0037-1612613

Cited by 7 publications

(11 citation statements)

References 2 publications

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“…Metallic embolus that may be originated from the heart valve prosthesis, suture materials and/or CORKNOT® has been reported to the literature few times [ 7 , 24 ]. Despite the fact that COR-KNOT® was proven in Ex-vivo model [ 4 , 25 ] in terms of its sutures security, strength, and consistency; such detrimental rare event may happen.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

Sazzad

Xian

Ler

et al. 2021

J Cardiothorac Surg

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Background CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. Results In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. Conclusion We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.

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Section: Discussionmentioning

confidence: 99%

“…Valvular regurgitation associated with the use of CORKNOT® has also been reported [ 6 ]. Delayed metallic embolization of the CORKNOT® fasterner [ 7 ] may also indicate the need for long-term surveillance in patients.…”

Section: Introductionmentioning

confidence: 99%

Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

Sazzad

Xian

Ler

et al. 2021

J Cardiothorac Surg

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“…Five years later, the patient presented with stroke and was found to have metallic embolus within the right MCA associated with adjacent thrombus. The source of metallic density was thought to be Cor-Knot titanium fastener used in mitral valve repair surgery 5…”

Section: Discussionmentioning

confidence: 99%

Metallic embolus to the brain in a patient with mechanical heart valves: an extremely rare complication

Sagheer¹,

Sheikh

Hallstrom

et al. 2019

BMJ Case Rep

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A 46-year-old man with a medical history of rheumatic valve disease underwent mitral and aortic valve replacements with On-X and CarboMedics Top Hat supra-annular mechanical valves, respectively. Seven months after the valve replacement surgery, the patient presented with dizziness. A CT scan of the brain was done as part of a thorough workup of dizziness. The CT scan revealed a small metallic density in the M2 branch of the right middle cerebral artery. The metallic density was believed to be a metallic embolus that originated from the mechanical valves or the suturing material, that is, Cor-Knot fastener. Although in our case, the dizziness was believed to be the result of benign paroxysmal positional vertigo, through this case, we aim to highlight this extremely rare structural complication of mechanical valves. This complication can have serious and potentially fatal consequences such as embolic component-related stroke or another organ infarction.

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“…Cor-Knot is the potential for complications, with multiple cases of metallic emboli 28,29 and leaflet perforation being reported. [15][16][17][18] LSI Solutions acknowledge an overall incidence of 0.00015% for adverse events whilst using Cor-Knot for any given procedure.…”

Section: Another Conceivable Barrier To the Universal Adoption Ofmentioning

confidence: 99%

“…A full thickness injury to the left coronary sinus has also been reported, 18 although LSI Solutions attributed this adverse event to a combination of operator error and unusually thin tissue. Furthermore, a case report describes a metallic brain embolus causing a stroke 5 years after a patient underwent robotic MV repair with Cor‐Knot 28 . Despite both the author and the company concluding that this embolus was not a result of the titanium clip, 7 it is emphasized by the author that Cor‐Knot technology requires long‐term surveillance 28 …”

Section: Cor‐knot In Mitral Valve Surgerymentioning

confidence: 99%

The role of Cor‐Knot in the future of cardiac surgery: A systematic review

Jenkin

Prachee

Sokal

et al. 2020

Journal of Cardiac Surgery

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Objective: The Cor-Knot automated fastener has been used to eliminate the need for manual knot-tying in cardiac valve surgery for over a decade. We review the current literature pertaining to Cor-Knot and discuss its benefits and shortcomings with respect to cardiac valve surgery. Methods: A comprehensive literature search was conducted to identify articles discussing the use of automated fasteners and manually tied knots in the setting of cardiac valve surgery. The search terms used were "heart", "valve surgery", "cardiac", "Cor-Knot", "fastener", "automated fastener", "aortic valve", "mitral valve", "minimally invasive", and "titanium". These terms were used as keywords and, in combination, as MeSH terms to maximize the output of literature searches. Twenty-four relevant articles were identified and reviewed. Results: Current literature provides evidence to support the role of Cor-Knot in facilitating enhanced intraoperative efficacy by reducing total operation times as compared with manual knot-tying. However, studies to date fail to provide evidence for the translation of these intraoperative advantages into improved patient outcomes. Moreover, Cor-Knot is associated with a significant financial burden. Conclusion: A plethora of evidence exists to support the intraoperative advantages provided by Cor-Knot. However, the literature is yet to support its role in facilitating superior clinical outcomes as compared with manual knot tying. Larger high-quality trials and studies are required to provide evidence supporting the ongoing use of Cor-Knot in valve surgery.

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Delayed Metallic Embolization of a Cor-Knot Fastener

Cited by 7 publications

References 2 publications

Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

Metallic embolus to the brain in a patient with mechanical heart valves: an extremely rare complication

The role of Cor‐Knot in the future of cardiac surgery: A systematic review

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