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On-pump fibrillating heart mitral valve replacement with the SAPIEN™ XT transcatheter heart valve

Enrico Ferrari1, Lars Niclauss, Didier Locca

  • 1Department of Cardiac Surgery, University Hospital of Lausanne, Lausanne, Switzerland.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|July 13, 2013
PubMed

Insights

A novel hybrid technique offers a less invasive option for mitral valve replacement in high-risk patients. This approach uses transcatheter stent-valves, reducing surgical risks for redo patients and those with prior aortic valve replacement.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Biomaterials Science

Background:

  • Standard mitral valve replacement (MVR) poses significant risks, particularly extensive annular decalcification, in high-risk patient groups.
  • High-risk redo sternotomy patients and those with prior transcatheter aortic valve implantation (TAVI) are vulnerable to calcific mitral valve disease.
  • Minimally invasive and transcatheter techniques are needed to mitigate surgical risks and complexity in mitral valve interventions.

Observation:

  • A hybrid technique involving transcatheter, balloon-expandable Sapien™ XT stent-valves was employed for mitral valve replacement.
  • The procedure was performed via right thoracotomy and left atriotomy on an on-pump fibrillating heart.
  • This approach was utilized in patients with calcified, degenerated mitral valves, including redo sternotomy and concomitant TAVI cases.

Findings:

  • The described hybrid technique provides an attractive alternative to standard MVR for specific high-risk patient populations.
  • This method potentially decreases surgical risk and technical complexity compared to conventional open-heart surgery.
  • Successful implantation of transcatheter stent-valves in the mitral position was achieved.

Implications:

  • This hybrid MVR approach may expand treatment options for complex mitral valve disease in high-risk surgical candidates.
  • It highlights the potential of combining transcatheter valve technology with minimally invasive surgical approaches.
  • Further research and clinical evaluation are warranted to establish the long-term efficacy and safety of this hybrid technique.

Keywords:
High-risk patientsMitral valve replacementMitral valve stenosisTranscatheter valve replacement

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