Transatrial implantation of a transcatheter heart valve for severe mitral annular calcification

Fabien Praz, Omar K. Khalique, Raymond Lee, Ramesh Veeragandham, Hyde Russell, Mayra Guerrero, Ashequl M. Islam, David W. Deaton, Tsuyoshi Kaneko, Susheel K. Kodali, Martin B. Leon, Vinayak Bapat, Hiroo Takayama, Michael A. Borger, Isaac George

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Objective: To assess the outcomes of transatrial implantation of a transcatheter heart valve (THV) for the treatment of mitral valve disease with severe mitral annular calcification (MAC). Methods: Implantation of a balloon-expandable THV was performed on cardiopulmonary bypass via left atrial exposure in patients considered at risk for left ventricular outflow tract obstruction. The anterior mitral valve leaflet was systematically resected and pledgeted sutures were placed to enhance stability and reduce paravalvular leak. Results: Twenty-six consecutive symptomatic patients with severe MAC (mean age, 78 ± 7 years; 92% female; mean Society of Thoracic Surgeons score, 9.4 ± 4.8) were included at 6 different centers. Two patients (8%) received an Edwards Sapien XT (Edwards Lifesciences, Irvine, Calif), and 24 (92%) an Edwards Sapien 3 bioprosthesis (Edwards Lifesciences). Concomitant aortic valve replacement was performed in 11 patients. Technical success according to the criteria of the Mitral Valve Academic Research Consortium was achieved in all patients. The mean transmitral gradient decreased from 10 ± 5 to 4 ± 2 mm Hg (P <.001) with trace or mild regurgitation in all patients. An elevated mean transaortic gradient (30 mm Hg) was observed in 1 patient (4%). Five patients died during hospital stay (19%) and 2 additional between discharge and 30 days (30-day mortality: 27%). Sustained functional improvement was observed in the remaining patients. Conclusions: Transatrial implantation of a THV for the treatment of MAC is associated with high technical success despite unfavorable anatomy. In this early experience of very high surgical risk patients, 30-day all-cause mortality was high. Patients at particular risk appear to be those with chronic kidney disease requiring multiple valve surgery.

Original languageEnglish (US)
Pages (from-to)132-142
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number1
StatePublished - Jul 2018


  • mitral annular calcification
  • mitral regurgitation
  • mitral stenosis
  • mitral valve surgery
  • transcatheter valve

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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