Repeated mitral valve replacement in a patient with extensive annular calcification

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Prosthetic Valve Technology

Background:

• Severe mitral annular calcification presents significant technical challenges during mitral valve replacement surgery.
• Rheumatic heart disease necessitates complex valve interventions, including reoperations for prosthetic dysfunction.

Observation:

• A patient with a history of mitral and aortic valve replacement experienced prosthetic dysfunction due to extensive mitral annular calcification.
• Multiple reoperations were required due to complications including paravalvular leak and hemolytic anemia following initial mechanical valve implantation.
• Recurrent paravalvular leak and associated complications persisted despite aggressive debridement and implantation of different prosthetic valves.

Findings:

• A novel approach involving a Carpentier-Edwards bioprosthetic valve with equine pericardial patches successfully eliminated recurrent paravalvular leak.
• The pericardial patches were strategically placed to cover the calcified annulus and create a collar around the prosthesis, ensuring a secure seal.
• The patient achieved a favorable long-term outcome with no evidence of paravalvular leak or structural valve deterioration at 7 years postoperatively.

Implications:

• This case demonstrates the utility of bioprosthetic valves augmented with equine pericardial patches in managing complex mitral valve replacement with severe annular calcification.
• The technique offers a viable solution for recurrent paravalvular leaks, a common complication in challenging mitral annular calcification cases.
• This approach may improve long-term outcomes for patients undergoing revision mitral valve surgery with severe annular calcification.