Extracardiac Valved Conduit for Calcific Mitral Stenosis

Originally presented as a STSA/CTSNet Surgical Motion Picture at the 2016 STSA Annual Meeting. 

Objectives: Calcific mitral valve stenosis with severe mitral annular calcification may present a difficult challenge to the surgeon. Several techniques for mitral valve replacement have been described for these complicated cases including wide debridement of the calcium with reconstruction of the annulus; another reported method is anchoring the prosthetic valve to atrial tissue. The authors present their technique for bypass of the calcified mitral valve with an extracardiac valved conduit. The method is simple and appears to have low perioperative risk.

Methods: This video presents a patient with severe aortic stenosis, severe mitral valve disease with both stenosis and regurgitation, and coronary artery disease. Extensive calcification of the mitral valve and annulus complicated the procedure due to calcium extending through the myocardium.

Results: The patient underwent aortic valve replacement, correction of mitral regurgitation, bypass of the mitral valve with an extracardiac conduit, and coronary artery bypass. The video demonstrates details of constructing the conduit for mitral valve bypass, and postoperative images are shown.

Conclusion: Bypass of the mitral valve with a valved conduit is another option for treatment of severe calcific mitral stenosis with annular calcification. The procedure avoids risks of paravalvular leakage and bleeding that may develop with extensive debridement of the mitral annulus.

Copyright 2016, used with permission from the Southern Thoracic Surgical Association. All rights reserved.