Transcatheter Aortic Valve Implantation in Mitral Position in a Patient With Severe Mitral Annular Calcification

The authors present the surgical treatment performed for a 75-year-old woman with severe aortic and mitral stenoses due to postradiation therapy. There was severe mitral annular calcification in both the anterior and posterior annulus. She had severe mitral and tricuspid regurgitation and her right coronary artery (RCA) was occluded. During the preoperative evaluation, she was also diagnosed with a right upper lobe adenocarcinoma.

The surgical plan included aortic and mitral valve replacement, tricuspid repair, saphenous vein grafting to the RCA, and removal of the malignant nodule at the right upper lobe. Due to the severity of the mitral annular calcification and the fragility of the tissues, the authors decided to insert a transcatheter aortic valve in a reverse fashion to the mitral position. The authors also repaired the tricuspid regurgitation and replaced the aortic valve with a Perceval sutureless valve. Vein graft to the RCA was performed, and the right upper lobe nodule was removed. Cross-clamp time was 82 minutes and cardiopulmonary bypass time was 114 minutes.  Postoperative echocardiography showed a good functioning mitral valve.

Suggested Reading

El Sabbagh A, Eleid MF, Foley TA, et al. Direct transatrial implantation of balloon-expandable valve for mitral stenosis with severe annular calcifications: early experience and lessons learned. Eur J Cardiothorac Surg. 2018;53(1):162-169.