The “Annular Sandwich”: A Simple Method of Reinforcing a Friable Mitral Valve Annulus

In 6 patients undergoing prosthetic mitral valve replacement a ring of Teflon felt, instead of conventional Teflon pledgets, was used because of concern about seating a new prosthesis in a disrupted friable mitral valve annulus. The technique avoided the potential risk of pledget loss in the event of suture breakage and, in these patients, prevented postoperative paraprosthetic mitral valve regurgitation.