Mitral repair in patients with severely calcified annulus: feasibility, surgery and results

The study aim was to assess the feasibility and follow up data of extensive decalcification for mitral valve repair in patients with severely calcified mitral annulus, in order to avoid mitral replacement.

Between 1993 and 1998, among 2,318 patients who underwent mitral valve surgery at the Herz-Gefaess-Klinik GmbH, Bad Neustadt, a severely calcified mitral valve annulus was encountered in 30 patients (17 males, 13 females; mean age 60.7+/-14.6 years; range: 22 to 77 years). Nineteen patients (63%) were in NYHA class III or IV. Mitral valve repair was performed by temporary detachment of the leaflets, en-bloc resection of the annular calcium deposits and annular reconstruction. Concomitant procedures included coronary bypass grafting (n = 6), aortic valve replacement (n = 2) and tricuspid repair (n = 1). Follow up data were obtained by telephone interviews with cardiologists, family physicians and patients.

Postoperative Doppler echocardiography at discharge from hospital showed satisfactory mitral valve function in all patients. No residual regurgitation was found in 25 patients (83%), and trivial regurgitation in five (17%). Follow up was 100% complete; mean follow up was 3.2+/-1.6 years (range: 4 months to 6 years). There was one early death, and one late death, but no instance of annulus dehiscence. There were no thromboembolic complications, but two anticoagulation-related events. At the time of follow up, echocardiography was performed in 26 patients, and showed no residual regurgitation in 21 patients (81%) and trivial regurgitation in five (19%). Twenty-eight patients (93%) were in NYHA class I or II, and all described their quality of life as normal.

These results show that aggressive and complete annulus decalcification, including complete temporary detachment of the leaflets, can be performed safely in patients with a severely calcified mitral valve annulus. The study also showed that initially good results remained stable for up to six years postoperatively in these repair patients. Hence, decalcification is a safe and rapid procedure that produces excellent results.