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Surgical techniques for the treatment of mitral valve disease (MVD) have continuously evolved; however, anatomical details like severe annular calcification remain challenging and require sophisticated surgical strategies. Among patients with symptomatic MVD referred for surgical valve repair or replacement, four presented with circumferential calcification of the mitral annulus precluding conventional surgical techniques. Successful treatment by implanting a balloon-expandable transcatheter aortic heart valve using an antegrade surgical access was performed. The perioperative course and follow-up assessment (19.3 ± 21 months) were uneventful. Echocardiographic assessment confirmed a well-seated valve with normal function (mean 4.5 ± 0.6 mmHg). Surgical mitral valve replacement using a balloon-expandable transcatheter aortic bioprosthesis can be a valuable and attractive bailout strategy in patients with a heavily calcified mitral annulus

Surgical antegrade transcatheter mitral valve implantation for symptomatic mitral valve disease and heavily calcified annulus