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.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:89054 |
| Date | 16 January 2024 |
| Creators | Bagaev, Erik, Ali, Ahmad, Saha, Shekhar, Sadoni, Sebastian, Orban, Martin, Naebauer, Michael, Mehilli, Julinda, Massberg, Steffen, Oberbach, Andreas, Hagl, Christian |
| Publisher | MDPI |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 93 |
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