Mixed mitral valve disease in an irradiated chest with eggshell-like left atrium

Managing mixed mitral valve disease is particularly challenging in patients with prior chest irradiation and extensive calcification.

A 40-year-old man presents with severe symptomatic MR, renal impairment, and an unusual eggshell-like left atrium. Imaging reveals complex mitral anatomy and critical constraints for transcatheter therapy.

How would you approach treatment in this high-risk scenario?