Hybrid transatrial valve in mitral annular calcification: planning and midterm outcomes

Severe mitral annular calcification is a surgical challenge. The implantation of a Sapien-3^© valve in the mitral position through an open transatrial route is an option. We present early/midterm outcomes and analyse planning/technical issues of this option.

Under cardiopulmonary bypass sapien-3^© were implanted and secured with several U-stitch. We analyzed data from 2016 to 2022 in three tertiary center. All patients undergoing the described technique were included consecutively. Data were collected retrospectively from August 2022 to February 2023, and patients were asked about their quality of life (KCCQ-12). A preoperative planning has been done retrospectively to search information which may help the surgeon.

Twenty-one patients were included (70±5.6 years, STS-score: 5.65±3.69). Thirty postoperative days: three cardiovascular deaths (14%), 7 ≥2/4 leakage (33.8%), seven (39%) mean trans-mitral gradient >5 mmHg, one outflow tract obstruction, one early migration, no myocardial or stroke. 30-days to one-year: two cardiovascular deaths (12.5%), one endocarditis with stroke. One-year echocardiography: one leakage ≥2/4 (8%), eight mean trans-mitral gradient >5 mmHg (60%). Two-years: one hospitalization for heart failure (no added outcomes or death). Mid-term quality of life is significatively improved (preoperative-KCCQ.12: 36.76±23.46 vs. postoperative-KCCQ.12: 73.90±21.13, P value <0.05). Mortality decreased with center experience. CT-scan gives paramount information for the surgeon (existence and length of calcification-free leaflet for adding U-stitches, subvalvular apparatus).

This procedure is associated with mortality, which may decrease with the learning curve (CT-scan planning, technical details). Quality of life is improved and paravalvular leaks seem to decrease with time.