Abstract
BackgroundMitral annular calcification (MAC) occurs represents a challenge to surgeons during mitral valve (MV) surgery with increased perioperative risk.Case presentationWe 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.ConclusionDirect 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.
Highlights
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
Mitral annular calcification (MAC) occurs in 10% of the population with increasing prevalence with advancing age [1, 2] and it is independently associated with all-cause mortality [3]
It represents a challenge to surgeons during mitral valve (MV) surgery with up to 6 folds increase in perioperative risk [4]
Summary
Mitral annular calcification (MAC) occurs in 10% of the population with increasing prevalence with advancing age (up to 40% above 80 years) [1, 2] and it is independently associated with all-cause mortality [3]. We report in this paper a case of open surgery for mitral valve replacement (MVR) in a high-risk patient with severe MAC using the direct implantation of Sapien 3 valve that is designed for percutaneous use without the use of any adjunctive techniques and we reviewed the literature in this subject. This is the first case implanted directly without the use of fixation sutures or any other adjunctive techniques.
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