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

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, 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. In this case, during the TAVR procedure, the coplanar angle estimated from preoperative computed tomography scan was easily adjusted referencing the line of Cor-Knot in her aortic annulus without administrating contrast despite 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. We achieved mean aortic pressure gradient of 9 mm Hg without paravalvular leakage or conduction abnormalities. She was discharged to home the next day without renal injury.