On-pump fibrillating heart mitral valve replacement with the SAPIEN™ XT transcatheter heart valve
Selected in European Journal of Cardio-Thoracic Surgery by Rylski
Enrico Ferraria, Lars Niclaussa, Didier Loccab and Carlo Marcuccic
Eur J Cardiothorac Surg 2014;45:749-751
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Mitral valve replacement may represent a challenging procedure, especially in patients with calcified mitral valve annulus or those with previously implanted aortic valve prosthesis. Placing transcatheter, balloon-expandable Sapien™ XT stent-valves in calcified, degenerated mitral valves through a right thoracotomy, a left atriotomy and on an on-pump fibrillating heart, represents an attractive alternative to standard surgery.
Inclusion criteria: calcified mitral valve annulus, redo mitral valve repair, patients with concomitant aortic stent-valves, patients with a high-risk profile
- Access: right thoracotomy at fourth intercostal space
- Femoro-femoral cannulation for cardio-pulmonary bypass
- On-pump surgery with fibrillating heart
- Opening the left atrium and introduction of the delivery system across the mitral valve, deployment of the stent valve in mitral position with the three stay sutures assuring the anchorage, stent-valve placement and ballooning, closure of the left atrium
Authors described the hybrid technique for mitral valve replacement in high-risk patients. Balloon-expandable Sapien™ prosthesis seems to be most appropriate for on-pump fibrillating heart mitral valve replacement due to its low profile design. Additional sutures placed at the mitral valve annulus secure the valve and prevents its dislocation, however probably in case of severely calcified mitral valve or already implanted mitral valve ring, no extra sutures would be necessary. This hybrid technique is another step toward off-pump mitral valve replacement via a mini-thoracotomy or thoracoscopy. However, large prospective studies will be necessary to evaluate its efficacy and safety.