Background and Objectives: Mitral stenosis with extensive mitral annular calcification (MAC) remains surgically challenging in respect to clinical outcome. Prolonged surgery time with imminent ventricular rupture and systolic anterior motion can be considered as a complex of causal factors. The aim of our alternative hybrid approach was to reduce the risk of annual rupture and paravalvular leaks and to avoid obstruction of the outflow tract. A review of the current literature was also carried out. Materials and Methods: Six female patients (mean age 76 9 years) with severe mitral valve stenosis and severely calcified annulus underwent an open implantation of an Edwards Sapien 3 prosthesis on cardiopulmonary bypass. Our hybrid approach involved resection of the anterior mitral leaflet, placement of anchor sutures and the deployment of a balloon expanded prosthesis under visual control. Concomitant procedures were carried out in three patients. Results: The mean duration of cross-clamping was 95 31 min and cardiopulmonary bypass was 137 60 min. The perioperative TEE showed in three patients an inconspicuous, heart valve-typical gradient on all implanted prostheses and a clinically irrelevant paravalvular leakage occurred in the anterior annulus. In the left ventricular outflow tract, mild to moderately elevated gradients were recorded. No adverse cerebrovascular events and pacemaker implantations were observed. All but one patient survived to discharge. Survival at one year was 83.3%. Conclusions: This “off label” implantation of the Edwards Sapien 3 prosthesis may be considered as a suitable bail-out approach for patients at high-risk for mitral valve surgery or deemed inoperable due to extensive MAC.

Novel biomaterials provide a spectrum of possibilities. They can be engineered in different forms to understand how they would perform as different bioprosthetic conduits. Bacterial cellulose membranes may be suitable candidates as prosthetic valve leaflets in valve replacement surgeries due to their functional properties (hemodynamics, resistant to thrombosis). Biomaterials used for most bioprosthetic heart valves are cut, trimmed and sutured. A major challenge for the bi-leaflet configuration is that the cutting and suturing of biopolymers fabricated as sheets into a cylindrical form increases failure risk due to greater number of suture points and irregular coaptation. The objective was to culture the bacterial cellulose membrane as a continuous cylindrical construct and evaluate its mechanical properties. Various design features of the fabrication process such as culturing media and the hollow carrier-mandrel characteristics were evaluated. A comparative study of how bacterial cellulose grows on different hollow carrier membranes was conducted and thin smooth surface silicone tubes fabricated in the lab were found to be most suitable. A bioreactor for culturing cylindrical bacterial cellulose tubes on the outer surface of the hollow carrier was designed and fabricated. The mechanical properties of the fabricated tubes, specifically, their tensile strength, flexure, suture retention and tear resistance were characterized. Mechanical characterization studies showed the cylindrical bacterial cellulose tubes to be anisotropic, with preferential properties in the longitudinal (axial) direction of the tube. Preliminary results show that cylindrical bacterial cellulose tubes can be a promising candidate for use in prosthetic valve conduits.