Key result
HeartMate 3 implantation preserving the sewing ring yields zero thromboembolic events at 12 months.
Why the study?
Management of a pre-existing mechanical mitral valve prosthesis during durable LVAD implantation remains controversial, as retaining the prosthesis risks thrombosis and inflow obstruction, whereas complete replacement adds operative risk.
Is intentional leaflet fracture and sewing ring preservation a feasible and safe strategy during HeartMate 3 implantation in a patient with a pre-existing mechanical mitral valve prosthesis?
Case Report (n=1)
Is intentional leaflet fracture and sewing ring preservation a feasible and safe strategy during HeartMate 3 implantation in a patient with a pre-existing mechanical mitral valve prosthesis?
Intentional fracture and removal of mechanical mitral valve leaflets with preservation of the sewing ring is a feasible alternative to full prosthetic replacement during LVAD implantation.
May balance thrombosis and redo operative risks in LVAD implantation; hypothesis-generating and requires prospective validation before adoption.
Management of a pre-existing mechanical mitral valve prosthesis during durable left ventricular assist device (LVAD) implantation remains controversial. Retaining the prosthesis may predispose to leaflet immobility, thrombosis, and inflow obstruction, whereas full prosthetic replacement adds substantial operative risk, particularly in redo cardiac surgery. We describe a novel surgical strategy combining removal of the mobile prosthetic components with preservation of the sewing ring during HeartMate 3 implantation. A 49-year-old woman with advanced heart failure and previous mechanical mitral valve replacement underwent HeartMate 3 implantation with concomitant tricuspid annuloplasty. The prosthetic leaflets and visible pivot components were intentionally fractured and removed, while the sewing ring was preserved in situ. At 12-month follow-up, the patient remained clinically stable without thromboembolic events, device malfunction, or inflow obstruction. This strategy may represent a feasible alternative to complete prosthetic replacement in selected redo patients.
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Mansuroglu et al. (2026) conducted a case report in Advanced heart failure and previous mechanical mitral valve replacement (n=1). HeartMate 3 implantation with intentional leaflet fracture and sewing ring preservation was evaluated on Clinical stability, thromboembolic events, device malfunction, or inflow obstruction. HeartMate 3 implantation with intentional leaflet fracture and sewing ring preservation resulted in clinical stability without thromboembolic events or device malfunction at 12 months.
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