Work

Stepwise Annular Reconstruction for Redo Double-Valve Surgery in Severe Mitral Annular Calcification

Year: 2025

Type: article

Abstract: BACKGROUND: Redo aortic and mitral valve surgery with severe mitral annular calcification (MAC) and intervalvular fibrous body destruction is highly challenging; the Commando procedure is often a last resort. CASE SUMMARY: A 59-year-old man with prior mechanical aortic and mitral valve replacements presented with hemolytic anemia due to a mitral paravalvular leak. Imaging showed severe MAC and tricuspid regurgitation. Intraoperatively, massive calcification and insufficient native tissue precluded standard anchoring for implantation of the new mechanical valves. In addition to the standard Commando procedure, a bovine pericardial patch was used reconstruct a neo-mitral annulus. Recovery was uneventful. DISCUSSION: Bovine pericardial patches offer structural support when native tissue is inadequate, facilitating safe and durable outcomes in complex redo valve procedures. TAKE-HOME MESSAGES: This case illustrates a viable surgical strategy for high-risk redo double-valve procedures. Bovine patch reconstruction enabled stable valve implantation and functional restoration in the setting of extensive MAC.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106133

Authors: Mohammad Sharaf, Majed Tolah, Darko Radakovic, Dragan Opacic, Jan Gummert, Tomasz Gilis-Januszewski

Institutions: Bielefeld University, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850