Surgical mitral valve replacement using direct implantation of Sapien 3 valve in a patients with severe mitral annular calcification without adjunctive techniques, a case report

Abstract

Background: Mitral annular calcification (MAC) occurs represents a challenge to surgeons during mitral valve (MV) surgery with increased perioperative risk. Case presentation: We describe a challenging case of an elderly female patient with multiple comorbidities who presented with symptoms and signs of heart failure with a previous history of mechanical aortic valve replacement 15 years prior to presentation. Echocardiogram showed severe mitral stenosis and regurgitation with severe calcification of the mitral annulus. Given her high-risk profile and unavailability of suitable percutaneous therapeutic options we decided to replace her mitral valve with Sapien 3 valve under direct exposure. The case describes the technical details for the valve implantation and demonstrates the viability of this option in high risk surgical patients without the need for adjunct techniques like predilatation, additional supporting sutures or patches with a review of the literature on open surgical implantation of Sapien 3 valve. Conclusion: Direct open surgical implantation of Sapien 3 valve can be implanted safely in patients with severe MAC, without predilatation and without the use of other adjunctive techniques like fixation sutures or patches.

Hybrid Surgery for Severe Mitral Valve Calcification: Limitations and Caveats for an Open Transcatheter Approach

“…To this day, no standardized procedure has been established in clinical practice, since a large number of operational challenges have not yet been addressed, such as impending ventricular rupture and systolic anterior motion. Praz et al and Russel et al have described adjunctive procedures with the use of polytetrafluoroethylene (PTFE) strips to provide further stability to the annulus [6,13], whereas others report transcatheter mitral valve replacement without adjunctive procedures [5,12,23,41].…”

Right Mini-Thoracotomy Beating-Heart Mitral Valve Replacement With a SAPIEN 3 Valve for Severe Circumferential Mitral Annular Calcification

“… 2 , 3 , 4 Recent studies have reported outcomes of open surgical implantation of a transcatheter heart valve (THV) in the mitral position in high-risk patients with severe MAC and mitral stenosis. 5 , 6 , 7 , 8 In some cases, such as porcelain aorta, application of a cross-clamp is not safe. For those patients, a beating-heart, minimally invasive MVR with a SAPIEN 3 THV (Edwards Lifesciences, Irvine, CA) is an option.…”