{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:01Z","timestamp":1753876201762,"version":"3.41.2"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"vor","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Mitral annular calcification (MAC) is common in the elderly. Extensive calcification has been historically challenging for the cardiac surgeons, with traditional surgical approaches carrying significant risks. Less invasive approaches have recently been explored in an attempt to reduce this risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We report the case of a 75-year-old woman who presented with recurrent pulmonary oedema, due to severe MAC and mitral regurgitation. Her past medical history included bioprosthetic aortic valve replacement 5 years ago. Given the extensive MAC and the patient\u2019s frailty, a minimally invasive hybrid approach with direct implantation of a transcatheter balloon expandable Sapien 3 valve was selected to manage her. Although the post-surgical result was initially excellent with elimination of the mitral regurgitation, the patient\u2019s post-operative course was marked by two serious complications, namely, acute severe aortic regurgitation, due to rupture of the bioprosthetic valve\u2019s right cusp, and severe paravalvular leak of the Sapien valve, due to posterior migration towards the left atrium. These were managed successfully with emergency valve-in-valve implantation using the \u2018double chimney\u2019 technique for the bioprosthetic aortic valve, as well as transeptal valve-in-valve implantation of a 2nd Sapien valve in the mitral valve, which sealed the gap between the 1st Sapien and the calcified mitral annulus.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This case illustrates a less invasive approach for the management of severe MAC. Complications can still occur in this high-risk group of patients, and therefore, such cases should be managed with close collaboration between cardiac surgeons and cardiologists, in centres with high expertise.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae333","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T08:02:41Z","timestamp":1720684961000},"source":"Crossref","is-referenced-by-count":0,"title":["Pushing the hybrid approach to the edges, three stories in one: a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6691-9277","authenticated-orcid":false,"given":"Sotirios","family":"Dardas","sequence":"first","affiliation":[{"name":"Department of Interventional Cardiology, St Luke\u2019s Hospital , Panorama, Thessaloniki, 55236 , Greece"},{"name":"Department of Cardiology, University Hospitals of Derby and Burton NHS Foundation Trust , Royal Derby Hospital, Uttoxeter Rd, Derby, DE22 3NE , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petros","family":"Dardas","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, St Luke\u2019s Hospital , Panorama, Thessaloniki, 55236 , Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Mezilis","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, St Luke\u2019s Hospital , Panorama, Thessaloniki, 55236 , Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Tsikaderis","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, St Luke\u2019s Hospital , Panorama, Thessaloniki, 55236 , Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodoros","family":"Kofidis","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Center , Singapore City , Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"2024072711012886300_ytae333-B1","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/j.cjca.2019.12.008","article-title":"Minimally invasive hybrid approach to high-risk mitral disease with severe mitral annular calcification","volume":"36","author":"de Waard","year":"2020","journal-title":"Can J Cardiol"},{"key":"2024072711012886300_ytae333-B2","doi-asserted-by":"crossref","first-page":"1033565","DOI":"10.3389\/fcvm.2022.1033565","article-title":"Mitral annular calcification in patients with significant mitral valve disease: an old problem with new solutions","volume":"9","author":"Ascione","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2024072711012886300_ytae333-B3","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1016\/j.jacc.2022.09.037","article-title":"2-Year outcomes of transcatheter mitral valve replacement in patients with annular calcification, rings, and bioprostheses","volume":"80","author":"Eleid","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2024072711012886300_ytae333-B4","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur Heart J"},{"key":"2024072711012886300_ytae333-B5","doi-asserted-by":"crossref","first-page":"e008425","DOI":"10.1161\/CIRCINTERVENTIONS.119.008425","article-title":"Thirty-day outcomes of transcatheter mitral valve replacement for degenerated mitral bioprostheses (valve-in-valve), failed surgical rings (valve-in-ring), and native valve with severe mitral annular calcification (valve-in-MAC) in the United States: data from the Society of Thoracic Surgeons\/American College of Cardiology\/Transcatheter Valve Therapy Registry","volume":"13","author":"Guerrero","year":"2020","journal-title":"Circ Cardiovasc Interv"},{"key":"2024072711012886300_ytae333-B6","doi-asserted-by":"crossref","first-page":"e031118","DOI":"10.1161\/JAHA.123.031118","article-title":"Feasibility and outcomes of mitral transcatheter edge-to-edge repair in patients with variable degrees of mitral annular calcification","volume":"12","author":"Hatab","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"2024072711012886300_ytae333-B7","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1053\/j.semtcvs.2021.04.053","article-title":"Partial upper sternotomy is a safe alternative in mitral annulus decalcification","volume":"34","author":"Oezpeker","year":"2022","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2024072711012886300_ytae333-B8","doi-asserted-by":"crossref","first-page":"19","DOI":"10.17925\/HI.2023.17.1.19","article-title":"Transcatheter mitral valve replacement in patients with mitral annular 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