First Experience With a Novel Self-Expandable Valve for Mitral Annular Calcification Guided by Three-Dimensional Printing

Transcatheter mitral valve replacement (TMVR) may emerge as a surgical alternative for high-risk patients with severe mitral annular calcification (MAC), yet several questions remain to be addressed. We present the case of a 67-year-old high-risk female patient with severe MAC (MAC score = 8) and mitral stenosis (effective orifice area = 121.3 mm²). To avoid conventional high-risk surgery, we opted to perform the TMVR using the novel Mi-thos system via the transapical approach. We utilized a patient-specific three-dimensional printed model derived by preprocedural computed tomography angiography data to assess the feasibility of the novel device and to guide the operation, mitigating potential challenges. The successful outcome of the guided procedure led to symptomatic improvement in the patient. This case represents the first experience with the novel Mi-thos system for TMVR in a patient with severe MAC. Guided by a patient-specific three-dimensional printed model, the dedicated transcatheter heart valve may be a feasible and safe option for high-risk patients with severe MAC.