Usage of Valved Conduit in Replacing the Mitral Valve in Heavily Calcific or Destroyed Annulus: A Prospective Cohort study

Background: Heavily calcified or destroyed mitral annulus present significant technical challenges for conventional valve replacement, often requiring alternative surgical strategies. Aim: To evaluate the safety, efficacy, operative outcomes, and the competency of valved conduit in patients with heavily calcified or destroyed mitral valve annulus. Methods: Fifteen patients (mean age 58.8±8.21 years, 53.3% female) underwent valved conduit mitral valve replacement at the Cardiothoracic Surgery Department, National Heart Institute, General Organization for Teaching Hospitals and Institutes (GOTHI), Egypt. Preoperatively, 80% presented in NYHA class III-IV with mean ejection fraction of 37.6±7.65% and pulmonary artery pressure of 50.6±11.39 mmHg. Bioprosthetic valves were used in 13.3% and mechanical in 86.7%. Concomitant procedures were performed in 26.7% of cases. Patients were followed for 12 months with serial echocardiographic and functional assessments. Results: Re-exploration was required in 20%. Postoperative arrhythmias occurred in 26.7%. Thromboembolic complications affected 20% of patients (stroke 13.3%, peripheral embolism 6.7%). 6.7 of bleeding cases were severe. Mean prosthetic gradients were 4.0 mmHg at 3 months and 5.73 mmHg at 12 months, with 13.4% still experiencing regurgitation and 6.7% of that being moderate. Gradually, functional status improved, and at 12 months, 60% had achieved NYHA class I-II. One-year mortality was 6.7%. Conclusion: For patients with heavily calcified annulus, a valved conduit offers a viable option that improves survivors' functional status and hemodynamics to an acceptable level.