Direct Transatrial Approach with Resection of the Anterior Mitral Leaflet to Prevent Outflow Tract Obstruction
Fabien Praz
Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
Search for more papers by this authorIsaac George
Division of Cardiothoracic Surgery, New York-Presbyterian/Columbia University Medical Center, New York City, NY, USA
Search for more papers by this authorFabien Praz
Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
Search for more papers by this authorIsaac George
Division of Cardiothoracic Surgery, New York-Presbyterian/Columbia University Medical Center, New York City, NY, USA
Search for more papers by this authorRon Waksman
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
Search for more papers by this authorToby Rogers
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
Search for more papers by this authorSummary
Advanced mitral valve (MV) stenosis and/or regurgitation, in conjunction with severe annular calcification, represent a challenge for a cardiac surgeon. Although preemptive laceration of the MV leaflet and preemptive or bailed-out alcohol septal ablation have been described for the treatment of anticipated or existing left ventricular outflow tract obstruction (LVOTO), the direct transatrial approach is the only one allowing for safe and complete resection of the anterior leaflet. This, together with the implantation of a transcatheter heart valve consisting of an open stent frame, has been shown to almost eliminate the risk of LVOTO, even in patients deemed at high risk. Further investigation is needed in order to understand which patients are optimal candidates based on procedural timing, comorbidities, as well as anatomy of the MV complex and left ventricular outflow tract.
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