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Extracardiac Valved Conduit for Calcific Mitral Stenosis

Tuesday, February 7, 2017

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.


Very interesting idea! I noted that you haven't shown preoperative CT. I wonder if it was a planned procedure you had to perform it after the revision of the valve? Is it a first ever performed MV bypass? What about follow-up of the patient?
Nice to see that a procedure introduced 30 years ago for complex congenital heart defects can be successfully applied for a difficult situation in an adult patient. Corno AF, et al. The hypoplastic mitral valve. When should a left atrial left ventricular extracardiac valved conduit be used? J Thorac Cardiovasc Surg 1986;91:848-51
Fantastic video and technique. The concerns would be bleeding from difficult to access suture lines and kinking of the graft so clearly meticulous technique required as demonstrated here. Very impressive.
And since a colleague asked about the follow-up, this is the report with the results up to 5 year follow-up period. Amodeo A, Corno AF, et al. Systemic atrioventricular conduit for extracardiac bypass of hypoplastic systemic atrioventricular valve. Eur J Cardiothorac Surg 1990;4:601-4
This is a nice technique ,I perform this technique in 1980, in this case bypass from left atriotomy to left ventricular apex.The patient die ,and we found there was a kinking of the graft. I think is better perform the bypass from atriotomy to apex and is another option for treatment of severe calcific mitral valve with extensive annular and ventricular affectation.
Back in 1978 I did exactly the same procedure in a dog. I would stress that the native mitral valve must be oversewn to avoid potential mitral regurgitation later. This obviously requires brief CPB. This proved to me that the procedure was technically feasible in either children or adult. Unfortunately I spent my entire career having never encountered a patient that I thought was a suitable candidate. As the adult population ages, this procedure may be required occasionally.

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