“Atrialized” minimally invasive transcatheter mitral valve-in-MAC replacement to prevent outflow tract obstruction

Mitral valve replacement in the setting of severe mitral annular calcification remains a high-risk intervention, often complicated by poor outcomes with both conventional surgical and transcatheter techniques. A hybrid open transcatheter mitral valve-in-MAC procedure utilizing an atrialized implantation strategy offers a promising alternative to minimize the risk of left ventricular outflow tract obstruction. Meticulous preoperative planning with cardiac CT is essential to guide procedural strategy and optimize outcomes. • Atrialized open transcatheter mitral valve-in-MAC replacement is feasible. • An atrialized approach to valve-in-MAC reduces risk of LVOT obstruction. • Cardiac CT is crucial to guide optimal surgical valve replacement technique.