Obstruction of Right Coronary Leaflet Motion Caused by Malorientation of Automated Tied Knots Resulting in Late Signficant Regurgitation of an Aortic Bioprosthesis

Oleg Novoseltsev, Vera Hergesell, Peter Oberwalder, Igor Knez, Sotirios Spiliopoulos, Otto Dapunt

Medical University Graz, Graz, Austria

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objectives

The CoreKnot device (LSI Solutions, Victor, NY, USA) is routinely used in minimally- invasive and increasingly in conventional valve procedures. We describe the case of obstruction of right coronary leaflet motion resulting in late significant aortic bioprosthesis regurgitation caused by malorientation of an automated tied knot in the region of right coronary cusp surgical annulus.

Methods

A 72 years old, male, Caucasian patient with history of bioprosthetic aortic valve replacement for aortic valve stenosis was admitted 8 months later for further evaluation of progressive congestive heart failure symptoms. Echocardiography documented severe regurgitation of the aortic bioprosthesis resulting from obstruction of right coronary leaflet motion. During reoperation inspection of the prosthesis showed a pressure ulceration of the right coronary leaflet caused by a maloriented automated tied knot.

Results

The valve was exchanged in typical fashion. Intraoperatively, veno- arterial extracorporeal membrane oxygenation was implemented as temporary mechanical circulatory support due to postcardiotomy syndrome. Unfortunately patient failed to recover and died at postoperative day 9 because of multiorgan failure.

Conclusions

This case demostrates that besides  leaflet perforation, malorientation of an automated tied knot can also lead to restriction of leaflet motion resulting in severe bioprosthesis regurgitation.