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Updated: Jan 14, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Recurrent STEMI After Surgical Aortic Valve Replacement
Shanjot Brar1, Suleman Aktaa2, Krishnan Ramanathan1
1Department of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada.
Background:
A 63-year-old man underwent surgical aortic valve replacement with an On-X valve using COR-KNOT suturing to facilitate a mini-sternotomy approach.
Case Summary:
The patient presented with recurrent inferior ST-segment elevation myocardial infarctions over a few-year period, despite optimal anticoagulation therapy. Repeated coronary angiography showed no obstructive coronary artery disease or thromboembolic occlusion. Intravascular ultrasound showed a filling defect in the ostium of the right coronary artery (RCA). A cardiac computed tomography confirmed the interference between a COR-KNOT and the RCA. Percutaneous coronary intervention of the RCA ostium was performed with good outcomes.
Discussion:
This is the first case to report a ST-segment elevation myocardial infarction caused by an automated suturing. The combination of mini-sternotomy with COR-KNOT may have contributed to this rare but serious complication.
Take-Home Messages:
Multimodality imaging is crucial in establishing unusual diagnoses. COR-KNOT may interfere with coronary flow resulting in transient coronary occlusion when used in surgical aortic valve replacement.
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