RF09 BEST OF BOTH WORLDS: DIRECT-VISION BALLON-EXPANDABLE TRANSCATETHER PROSTHESIS WITH EXCISION OF ANTERIOR MITRAL LEAFLET TO TREAT SEVERE STENOSIS IN BIG MITRAL ANNULAR CALCIFICATION PATIENTS

Abstract

Background and aim: The mitral annular calcification (MAC) is one of the most demanding and exciting challenges for the cardiac surgeon. Numerous surgical techniques to approach MAC have been described, and many include decalcification and annular reconstruction. The aim of this study is to describe an alternative method of treatment of the MAC, performing surgical implant of a prosthesis designed for the percutaneous implant in aortic position under direct vision and to define the applicability criteria. Methods: Preoperative evaluation is a key point to define the possible treatment options of the MAC. The CT-scan is the fundamental tool that allows quantification of calcium and its possible extension in the underlying myocardium. An indispensable criterion is that the calcification interests the annulus in an almost completely circumferential manner, in such a way as to allow a safe deployment prosthesis. Results: We report a surgical approach to manage MAC and avoid calcium debridement by using a prosthesis designed for TAVI procedures. The anulus is measured with an Egar dilator and part of the anterior mitral leaflet is removed which creates room for a bigger implant. An Edwards SAPIEN 3 Transcatheter Heart Valve is implanted in the mitral annulus under direct vision and then the crimped valve is deployed with a manual inflation device. Inflation of the ventricle with saline allows to identify any valvular leaks and correct them by placement of one or more stitches. Conclusions: This technique seems a safe and effective solution for treating the MAC in selected cases.