Open transcatheter aortic valve implantation in the mitral position for severe MAC showed 18.2% 30-day mortality and no late device complications in 11 patients.
Does open transcatheter aortic valve implantation in the mitral position provide a safe and feasible alternative for patients with severe mitral annular calcification?
Implantation of a transcatheter aortic valve in the mitral position during open surgery is a viable alternative for patients with severe mitral annular calcification.
Tasa de eventos absoluta: 0% vs 0%
Introduction Mitral annular calcification (MAC) presents a significant surgical challenge, often rendering conventional surgery high risk. The presence of a heavily calcified, rigid, and friable annulus significantly increases the risk of complications such as atrioventricular groove disruption, annular rupture, and paravalvular leak. Open transatrial implantation of balloon‐expandable aortic valves has emerged as a hybrid alternative for selective patients, yet clinical data remain limited. Method We present a multicentre case series detailing the use of a transcatheter aortic valve implanted in the mitral position via an open trans‐atrial approach in patients with severe MAC. Results Eleven consecutive patients with severe MAC, mitral valve disease and a median EuroSCORE II of 3.08 (3.15), were treated between February 2019 and June 2025. All cases were performed under cardiopulmonary bypass via median sternotomy with two (18.2%) undergoing redo sternotomy. Concomitant surgical procedures were performed in 9 (82.8%) patients, including aortic valve replacement (AVR) in 6 (66.6%) patients and coronary artery bypass grafting (CABG) in 4/9 (44.4%) patients. The valve was appropriately deployed in all patients, with no more than mild paravalvular leak. Median transmitral gradient was 5.1 mmHg (IQR 3.9). Thirty‐day mortality was 18.2% ( n = 2) in both patients undergoing redo sternotomy. At a median follow‐up of 12 weeks (range 6–56 weeks), all other patients were alive with stable transvalvular gradients. There were no instances of device migration, embolisation or late LVOT obstruction. Conclusion In patients with severe MAC, implantation of transcatheter aortic valve in the mitral position during open surgery represents a viable surgical alternative to conventional mitral valve replacement, with or without extensive annular decalcification.
Kayyal et al. (Thu,) reported a other. Open transcatheter aortic valve implantation in the mitral position for severe MAC showed 18.2% 30-day mortality and no late device complications in 11 patients.