Intra-atrial placement of a mitral prosthesis in patients with severe mitral annular calcification

The safety and durability of intra-atrial placement of mitral valve prostheses in patients with severe mitral annular calcification (MAC) were evaluated.

A retrospective analysis was conducted of all patients with severe MAC who underwent intra-atrial placement of a mitral valve prosthesis between September 2008 and August 2011, by placement of an 8 mm Dacron graft sutured circumferentially around the sewing cuff. Both, intraoperative and postoperative echocardiography were performed to evaluate the adequacy of prosthesis placement and to assess the presence of mitral regurgitation (MR).

A total of six patients (three males, three females; mean age 78 +/- 9.7 years) was identified. The median EuroSCORE risk calculation was 14.5 (IQR 13-18), and three patients had a history of previous cardiac surgery. Three operations were performed via a minimally invasive approach. Three patients underwent concomitant coronary artery bypass graft surgery; one of these patients also underwent aortic valve replacement. All prostheses were placed successfully and no paravalvular leaks were observed postoperatively. There was one in-hospital mortality. The median aortic cross-clamp time was 176 min (IQR 156-190 min) and the median cardiopulmonary bypass time 178 min (IQR 156-218 min). The median preoperative versus postoperative MR grade was 3 (IQR 3-4) versus 0 (IQR 0-0). Follow up echocardiography was performed on two patients on postoperative days 20 and 70, respectively, but there was no evidence of MR. The median total length of hospital of stay was 11 days (IQR 4-19 days).

In patients requiring mitral valve replacement in which severe annular calcification prohibits standard valve surgery, the intra-atrial placement of a mitral valve prosthesis is a feasible option.