Precision hybrid technique for direct SAPIEN-3 ultra™ implantation in extensive mitral annular calcification

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Biomaterials Science

Background:

• Extensive mitral annular calcification (MAC) presents significant challenges in mitral valve surgery.
• Traditional surgical approaches involve risks of peri-operative complications due to extensive decalcification.
• Transcatheter valve implantation is evolving, with hybrid techniques emerging for high-risk MAC patients.

Purpose of the Study:

• To describe a specific surgical technique for implanting a SAPIEN-3 Ultra™ transcatheter valve in the mitral position.
• To address key technical considerations, including prosthesis sizing and deployment timing.
• To present an emerging treatment option for patients with extensive mitral annular calcification.

Main Methods:

• Hybrid technique combining open-heart surgery with transcatheter valve implantation.
• Implantation of a SAPIEN-3 Ultra™ prosthesis in the mitral position.
• Detailed description of surgical steps focusing on annulus sizing and deployment phases.

Main Results:

• The described technique facilitates the implantation of a transcatheter valve in the mitral position for patients with extensive MAC.
• Key surgical steps for successful prosthesis sizing and deployment are highlighted.
• This approach represents a potential solution for high-risk patients unsuitable for conventional surgery.

Conclusions:

• The hybrid technique offers a viable, albeit off-label, alternative for managing mitral annular calcification.
• Further standardization and investigation are needed to optimize this emerging procedure.
• Successful implantation relies on meticulous attention to prosthesis selection and deployment technique.