{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:06:18Z","timestamp":1779379578202,"version":"3.53.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Mitral valve surgery in patients with extensive mitral annular calcification remains challenging. Different surgical approaches have been described: from a complete decalcification and reconstruction of the mitral annulus to other techniques where a full debridement was avoided to minimize the risk of possible peri-operative complications. In the current era of transcatheter valve implantation, the issue of mitral annulus calcification has been addressed by some with the adoption of a hybrid technique, where a transcatheter aortic valve is implanted in mitral position, during open heart surgery. This technique is emerging as a treatment option for high-risk patients although it is still an off-label procedure and needs further standardization. We describe here our surgical technique to implant a SAPIEN-3 Ultra\u2122 in mitral position, addressing some of the key points in the surgical technique: the appropriate sizing and the phase of deployment of the prosthesis.<\/jats:p>","DOI":"10.3389\/fmed.2026.1748471","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:21:34Z","timestamp":1779376894000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Precision hybrid technique for direct SAPIEN-3 ultra\u2122 implantation in extensive mitral annular calcification"],"prefix":"10.3389","volume":"13","author":[{"given":"Gianluca","family":"Lucchese","sequence":"first","affiliation":[{"name":"Cardiovascular Department, St. Thomas\u2019 Hospital","place":["London, United Kingdom"]},{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajdeep","family":"Bilkhu","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, St. Thomas\u2019 Hospital","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Bivona","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, St. Thomas\u2019 Hospital","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Caruso","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, St. Thomas\u2019 Hospital","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1934","DOI":"10.1016\/j.jacc.2015.08.872","article-title":"Mitral annulus 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