A case of open atrial implantation of a rapid deployment valve in a patient with severe mitral annular calcification

Abstract

A, Calcified mitral valve annulus. B, Inverted Edwards Intuity valve. C, Implanted valve. CENTRAL MESSAGEAn inverted Edwards Intuity Elite rapid deployment valve was implanted in the mitral position in a patient with severe mitral annular calcification.See Commentaries on pages 136 and 138.

Commentary: Trial and error—Is the transatrial approach the silver bullet for transcatheter mitral valve replacement in mitral annular calcification?

“…Postoperatively, the valve appeared to be well seated, without PVL or compromise of the adjacent TAVR valve in the aortic position, but with some degree of anatomic LVOT. This article exudes both technical prowess and innovation, and we commend Vodstrup and colleagues 4 for their unique approach given the challenging anatomy, albeit slightly overshadowed by the patient's minor stroke complication. Nonetheless, this article provides some food for thought, particularly with respect to their valve choice.…”

“…3,5 The transatrial approach may provide improved sealing to minimize PVL, better anchorage to mitigate valve migration, and, importantly, a better landing target to reduce LVOT, as observed in the study of Vodstrup and colleagues. 4 Contrastingly, transseptal access may limit maneuvers in the left atrial and compromise valve positioning given the Transcatheter mitral valve replacement in mitral annular calcification is associated with worse outcomes, but outcomes after transatrial access appear promising, and it should be considered.…”

“…We read with interest the article by Vodstrup and colleagues 4 in this issue of the Journal . They describe a first-in-human case of transatrial TMVR with an inverted 23 Edwards Intuity Elite (Edwards Lifesciences, Irvine, Calif) rapid-deployment valve (as opposed to using a TAVR valve in the mitral position) in a 72-year-old woman with severe circumferential MAC.…”

“… 3 , 5 The transatrial approach may provide improved sealing to minimize PVL, better anchorage to mitigate valve migration, and, importantly, a better landing target to reduce LVOT, as observed in the study of Vodstrup and colleagues. 4 Contrastingly, transseptal access may limit maneuvers in the left atrial and compromise valve positioning given the angled mitral annular plane, while transapical access may be limited by the myocardial tissue damage, particularly in elderly and frail patients. 3 , 5 The superiority of transatrial TMVR access in MAC was evident in the Global Multicenter Registry Analysis, in which the transatrial approach was used in 20% of the patients and was associated with higher technical success and significantly lower odds of 1-year mortality (almost 2.5-fold less) relative to the transapical and transseptal approaches.…”

Commentary: Surgical mitral-in-mitral annular calcification: Progress but not the solution

“…Vodstrup and colleagues 12 describe the placement of a rapid-deployment Intuity valve (Edwards Lifesciences) into the calcified mitral annulus of a 72-year-old patient with severe MAC with mitral stenosis. Sutures were placed through leaflet tissue and the anterior leaflet left intact.…”