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Open Transcatheter Mitral Valve Implantation Into The Native Mitral Valve For Inoperable Big Mac The Coulisse Technique
Marie-Elisabeth Stelzmueller, Robert Zilberszac, Ruediger Schernthaner, Guenther Laufer, Wilfried Wisser.
Medical University Vienna, Vienna, Austria.

OBJECTIVE:
Due to the growing population of elderly patients the prevalence of severe mitral annulus calcification (Big Mac) is increasing. The surgical techniques for Big Macs are technically demanding, despite of the technical aspect, up to one third of the patients are considered too high risk for conventional surgery, but are candidates for the coulisse-technique.
METHODS:
Between January 2016 and July 2019 5 patients (female n=3, median age 79 years) with a median logEuroScore of 23.5% and EuroScore II of 6.5% underwent a transcatheter mitral valve implantation into the native annulus in “coulisse technique”. The technique is based on implanting a transcatheter valve into a native mitral annulus. The anterior leaflet is folded apart, thus reducing risk for LVOT obstruction and risk for PVL and avoids valve migration. Preoperative planning, based on a CT scan, is mandatory.
RESULTS: The transcatheter valve implantation was successful in all patients, no valve migration or severe paravalular leakage was detectable in the postoperative technique. One patient died in hospital due to cardiac decompensation as a consequence of multiple organ failure based on his comorbidities. The mean postoperative follow up is 19,5 months. None of the patients showed a valve migration or developed a mid or severe paravalular leakage
CONCLUSIONS:
The big advantage of this technique is, that there is no need for additional sealing material to anchor the valve prosthesis. The coulisse technique folds the anterior leaflet apart, thus reducing risk for LVOT obstruction, reducing risk for paravalvular leaks. The coulisse technique is a promising alternative operation method for surgical inoperable Big Mac with satisfying mid-term results.


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