Hybrid Surgical Technique for Mitral Valve Replacement in Mitral Annular Calcification Utilizing a Modified Transcatheter Valve

Authors

Alessandro Vivacqua, Corewell Health East
Bogdan Kindzelski, Corewell Health East
Jeffrey Altshuler, Corewell Health East
Rakesh Suri, Corewell Health East
Amr Abbas, Corewell Health East
Ivan Hanson, Corewell Health East
Brian Renard, Corewell Health East
Thomas Schwann, Corewell Health East

Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

Structural Heart

Abstract

Background: Mitral valve replacement (MVR) in severe mitral annular calcification (MAC) is technically challenging due to increased risk of paravalvular leak, atrioventricular groove disruption and difficulty seating an adequately sized prosthesis. We present our results with a hybrid surgical procedure utilizing a transcatheter valve via an open atriotomy. Methods: From February 2019 to December 2024, 16 patients with severe MAC underwent the hybrid approach. All patients had a CTA for sizing and were reviewed by the Heart Team. Six patients had mitral stenosis, 6 had mitral regurgitation and 4 had combined disease. 6 patients with isolated mitral disease had a mini right thoracotomy and the rest had a sternotomy. In each case a felt strip was sewed to the skirt of the valve prior to crimping, the anterior mitral leaflet was excised, annular sutures were placed and the valve was deployed under direct visualization. Results: The mean patient age was 738.9 years and 13 patients (81.2%) were females. For patients in which the risk model was available, the mean STS score was 9.13.9. Five patients had concomitant aortic valve replacement (AVR), 3 had coronary artery bypass grafting (CABG), 1 had CABG and AVR. All patients had a 29 mm Edwards Sapien S3 valve implanted. There was 1 (6.2%) 30-day mortality. Three patients had prolonged ventilation and 2 had mild paravalvular leak. Conclusion: In this high risk cohort of patients with severe MAC, a hybrid surgical approach is feasible and provides a practical solution for a challenging problem. This technique should be part of a successful Heart Team armamentarium.

Volume

9

Issue

Suppl 1

First Page

47

Last Page

47

Recommended Citation

Vivacqua A, Kindzelski B, Altshuler J, Suri R, Abbas A, Hanson I, et al. [Renard B, Schwann T]. Hybrid surgical technique for mitral valve replacement in mitral annular calcification utilizing a modified transcatheter valve. Struct Heart. 2025 Jun;9(Suppl 1):47. doi:10.1016/j.shj.2025.100593

Comments

New York Valves: The Structural Heart Summit, June 25-27, 2025, New York, NY

DOI

10.1016/j.shj.2025.100593