Endoscopic mitral valve replacement in extensive mitral annular calcification with a posterior pericardial patch

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Minimally Invasive Procedures

Background:

• Extensive mitral annular calcification (MAC) poses significant challenges in mitral valve surgery.
• MAC is linked to increased operative risks, including atrioventricular disruption and prosthetic valve complications.
• Management strategies for severe mitral regurgitation with MAC are debated, even for transcatheter interventions.

Purpose of the Study:

• To present a case of severe symptomatic mitral regurgitation in a patient with extensive MAC.
• To describe the successful application of endoscopic mitral valve replacement in this challenging scenario.

Main Methods:

• The patient underwent endoscopic mitral valve replacement via right minithoracotomy with femoro-femoral cardiopulmonary bypass.
• An endoaortic balloon was used for cardiac arrest with cardioplegia.
• A bioprosthetic mitral valve was implanted, reinforced with a posterior skirt technique to mitigate paravalvular leak risk.

Main Results:

• The procedure successfully addressed severe mitral regurgitation.
• Postoperative echocardiography confirmed a well-functioning prosthetic valve and preserved left ventricular function.
• Only a trivial paravalvular leak was detected, indicating a successful outcome.

Conclusions:

• Endoscopic mitral valve replacement is a feasible and effective option for patients with extensive MAC unsuitable for transcatheter procedures.
• The posterior skirt technique can enhance prosthetic valve stability and reduce paravalvular leakage.
• Minimally invasive approaches can overcome technical challenges posed by severe MAC.