Building a new annulus: a technique for mitral valve replacement in heavily calcified annulus.

We describe the rationale, methodology, and our preliminary experience with a new surgical technique for mitral valve replacement in patients with severe calcification of the mitral annulus in which the conventional techniques can not be applied. In contrast with other procedures published in the literature for these patients, in which the placement of the prosthesis is supra-annular, we plicate both mitral leaflets and the atrial wall creating a new annulus that allows the intra-annular placement of the prosthesis.