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Mitral valve replacement for extensive calcification: half and half technique

Yasuyuki Bito1, Toshihiko Shibata, Takashi Yasuoka

  • 1Department of Cardiovascular Surgery, Kansai Rousai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan. ybito@med.osaka-cu.ac.jp

General Thoracic and Cardiovascular Surgery
|October 16, 2008
PubMed

Insights

This study presents a novel surgical technique for mitral valve replacement in a patient with severe mitral valve stenosis and extensive calcification. The technique successfully implanted a St. Jude valve in a supra-annular position, offering a viable solution for complex cases.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Repair
  • Biomaterials in Medicine

Background:

  • Mitral valve stenosis poses significant surgical challenges, particularly when associated with severe calcification of the mitral valve leaflet and annulus.
  • End-stage renal disease patients on long-term hemodialysis often present with complex comorbidities, including advanced calcific valve disease, complicating mitral valve replacement.
  • Traditional mitral valve replacement techniques may be inadequate in cases with extensive posterior annular calcification, necessitating innovative surgical approaches.

Observation:

  • A 50-year-old female patient undergoing long-term hemodialysis presented with severe mitral valve stenosis.
  • Intraoperative findings revealed extreme calcification of the mitral valve leaflet and annulus, rendering removal of the posterior leaflet impossible.
  • A modified surgical technique was employed, utilizing specific suturing methods to accommodate the calcified annulus.

Findings:

  • A supra-annular implantation of a 25-mm St. Jude valve was successfully achieved using a combination of noneverted and everted horizontal mattress sutures.
  • The supra-annular placement and the specific suture technique facilitated secure valve seating despite the challenging calcific anatomy.
  • The St. Jude valve's design, with reduced left ventricular leaflet protrusion, proved advantageous for this supra-annular implantation technique.

Implications:

  • This modified surgical approach offers a potential solution for mitral valve replacement in patients with severe annular calcification, a group often excluded from standard procedures.
  • The successful use of the St. Jude valve in a supra-annular position highlights its adaptability in complex reconstructive cardiac surgery.
  • Further research into this technique could expand treatment options for patients with complex calcific mitral valve disease, improving outcomes in challenging surgical scenarios.

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