%0 Online Multimedia %A Bernabei, Annalisa %A Eleid, Mackram F. %A Guerrero, Mayra %A Crestanello, Juan A. %D 2019 %T Modifications of Transatrial Transcatheter Mitral Valve Replacement Technique %U https://ctsnet.figshare.com/articles/media/Modifications_of_Transatrial_Transcatheter_Mitral_Valve_Replacement_Technique/10293386 %R 10.25373/ctsnet.10293386.v1 %2 https://ctsnet.figshare.com/ndownloader/files/18679127 %K Cardiac %K Mitral %K Valve %K Disease %K Education %K Surgery %X
Mitral valve replacement (MVR) in patients with mitral annular calcification (MAC) poses a significant surgical challenge. A direct transatrial transcatheter mitral valve replacement (TMVR) approach with resection of the anterior leaflet of the mitral valve has been described (1, 2). Patients with MAC usually have small hypertrophic ventricles at risk of left ventricular outflow tract (LVOT) obstruction even with resection of the anterior mitral leaflet (2, 3). The authors present two modifications of this technique aimed to avoid LVOT obstruction and improve sealing against the calcified mitral annulus.
Severe MAC is often associated with small hypertrophic ventricles, increasing the risk of LVOT obstruction during TMVR (2, 3). A direct transatrial approach under cardiopulmonary bypass with an arrested heart allows for the resection of the anterior leaflet of the mitral valve, decreasing the risk of LVOT obstruction. In addition, a septal myectomy can also be performed to further decrease this risk. Improved sealing of the transcatheter prosthesis to the mitral annulus is achieved by sewing a felt strip to the outside of the stent frame. While having a felt strip of the same height as the expanded Sapien 3 valve may improve sealing, it can also obstruct the LVOT. In this report, the authors describe two modifications to minimize that risk:
Conclusions:
The presented modified surgical technique improves sealing to minimize paravalvular regurgitation while decreasing the risk of LVOT obstruction.
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