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A Solution To MAC: Mitralring As Landing Zone For Transcatheter Mitral Valve Implantation
Nikolaos Bonaros1, Daniel Hoefer1, Adel Sakic1, Peter Mair1, Guy Friedrich1, Silvana Müller1, Michael Grimm1, Jörg Kempfert2, Ludwig Müller1.
1Innsbruck Medical University, Innsbruck, Austria, 2German Heart Center Berlin, Berlin, Germany.

BACKGROUND: Mitral annular calcification is a major surgical challenge in patients requiring mitral procedures due to the risk of atrioventricular dehiscence.
METHODS: We describe a the detailed steps of open mitral valve replacement using an annuloplasty ring to serve as landing zone for transatrial delivery of a balloon-expandable transcatheter valve.
RESULTS: In this video we describe the steps of the procedure and the benefits of using a circular transcatheter valve in a semi-rigid D-shaped annuloplasty ring. We also provide tricks to avoid paravelvular regurgitation and obstruction of the left ventricular outflow tract.
CONCLUSIONS: The technique is feasible and an promising solution in patients with MAC

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