Open Atrial Transcatheter Mitral Valve Replacement in Patients With Mitral Annular Calcification

Hyde M. Russell, Mayra Guerrero, Michael H. Salinger, Melissa A. Manzuk, Amit K. Pursnani, Dee Wang, Hassan Nemeh, Rahul Sakhuja, Serguei Melnitchouk, Ashish Pershad, H. Kenith Fang, Sameh M. Said, James Kauten, Gilbert H.L. Tang, Gabriel Aldea, Ted E. Feldman, Vinnie N. Bapat, Isaac M. George

Research output: Contribution to journalArticle

21 Scopus citations


Background: Mitral valve replacement in the setting of severe mitral annular calcification remains a surgical challenge. Transcatheter mitral valve replacement (TMVR) using an aortic balloon-expandable transcatheter heart valve is emerging as a potential treatment option for high surgical risk patients. Transseptal, transapical, or transatrial access is not always feasible, so an understanding of alternative implantation techniques is important. Objectives: The authors sought to present a step-by-step description of a contemporary transatrial TMVR technique using balloon-expandable aortic transcatheter heart valves. This procedure has evolved over time to address valve migration, left ventricular outflow tract obstruction, and paravalvular leak. The authors present a refined technique that has been associated with the most reproducible outcomes. Methods: A step-by-step description of the TMVR technique and outcomes of 8 patients treated using this technique are described. Baseline patient clinical and echocardiographic characteristics and 30-day post-TMVR outcomes are presented. Results: Eight patients underwent transatrial TMVR at a single institution. Five had previous cardiac surgery. Mean STS score was 8%. Technical success by MVARC (Mitral Valve Academic Research Consortium) criteria was 100%. There was zero in-hospital and 30-day mortality. Procedural success by MVARC criteria at 30 days was 100%. Paravalvular leak immediately post-implant was none or trace in 6 and mild in 1. Conclusions: The technique described is reproducible and was associated with favorable outcomes in this early experience. It represents a useful technique for the treatment of mitral valve disease in the setting of severe annular calcification. A structured and defined implantation technique is critical to investigators as this field evolves.

Original languageEnglish (US)
Pages (from-to)1437-1448
Number of pages12
JournalJournal of the American College of Cardiology
Issue number13
StatePublished - Sep 25 2018



  • mitral annular calcification
  • surgery
  • valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Russell, H. M., Guerrero, M., Salinger, M. H., Manzuk, M. A., Pursnani, A. K., Wang, D., Nemeh, H., Sakhuja, R., Melnitchouk, S., Pershad, A., Fang, H. K., Said, S. M., Kauten, J., Tang, G. H. L., Aldea, G., Feldman, T. E., Bapat, V. N., & George, I. M. (2018). Open Atrial Transcatheter Mitral Valve Replacement in Patients With Mitral Annular Calcification. Journal of the American College of Cardiology, 72(13), 1437-1448.