HeartMate 3 implantation in a patient with mechanical mitral valve prosthesis: intentional leaflet fracture and sewing ring preservation

Abstract Management of a pre-existing mechanical mitral valve prosthesis during durable left ventricular assist device (LVAD) implantation remains controversial. Retaining the prosthesis may predispose to leaflet immobility, thrombosis, and inflow obstruction, whereas full prosthetic replacement adds substantial operative risk, particularly in redo cardiac surgery. We describe a novel surgical strategy combining removal of the mobile prosthetic components with preservation of the sewing ring during HeartMate 3 implantation. A 49-year-old woman with advanced heart failure and previous mechanical mitral valve replacement underwent HeartMate 3 implantation with concomitant tricuspid annuloplasty. The prosthetic leaflets and visible pivot components were intentionally fractured and removed, while the sewing ring was preserved in situ. At 12-month follow-up, the patient remained clinically stable without thromboembolic events, device malfunction, or inflow obstruction. This strategy may represent a feasible alternative to complete prosthetic replacement in selected redo patients.