Open transatrial valve-in-MAC TMVR with native leaflet sealing achieved stable prosthesis apposition, no paravalvular leak, and improved functional status at 3 months in 3 high-risk patients.
Case Report (n=3)
Does open transatrial balloon-expandable valve implantation with native leaflet sealing improve outcomes in high-risk patients with severe mitral annular calcification?
Open transatrial balloon-expandable valve implantation with native leaflet sealing is a feasible and reproducible approach for patients with severe mitral annular calcification who are at high risk for complications with transseptal TMVR.
BACKGROUND: Severe mitral annular calcification (MAC) limits mitral intervention options. Transseptal valve-in-MAC (ViMAC) transcatheter mitral valve replacement (TMVR) risks neo-left ventricular outflow tract (neo-LVOT) obstruction and paravalvular leak, while surgical replacement requires extensive annular reconstruction. CASE SUMMARY: We report 3 high-risk patients with severe MAC (computed tomography CT-based MAC scores 7-10) who underwent open transatrial valve-in-MAC TMVR via a balloon-expandable valve after CT-based simulation and multidisciplinary heart review identified increased risk of valve malapposition or neo-LVOT obstruction precluding transseptal approach. Native anterior mitral leaflet tissue was preserved, everted, and fixed to the bioprosthetic valve cuff, creating a seal to address frame-annulus gaps. DISCUSSION: All patients achieved stable prosthesis apposition with no paravalvular leak, stable LVOT gradients, and significantly improved functional status at their 3-month follow-up. Two underwent concomitant aortic root replacement; one underwent concomitant septal myectomy and tricuspid repair. TAKE-HOME MESSAGES: CT-based simulation facilitates identification of patients who face increased risk of complications with transseptal TMVR. This series demonstrates reproducibility of native anterior mitral leaflet fixation to address frame-annulus gaps in transcatheter mitral replacement.
Saleh et al. (Wed,) conducted a case report in Severe mitral annular calcification (n=3). Open transatrial valve-in-MAC TMVR via a balloon-expandable valve with native leaflet sealing was evaluated on Prosthesis apposition, paravalvular leak, LVOT gradients, and functional status. Open transatrial valve-in-MAC TMVR with native leaflet sealing achieved stable prosthesis apposition, no paravalvular leak, and improved functional status at 3 months in 3 high-risk patients.
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