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Mitral valve repair in the extensively calcified mitral valve annulus
B el Asmar1, M Acker, J P Couetil
1Department of Cardiovascular Surgery, Hôpital Broussais, Paris, France.
Insights
Mitral valve repair is a safe and effective option for patients with a heavily calcified mitral annulus. This approach avoids the risks associated with mitral valve replacement surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Extensive mitral annular calcification (MAC) increases risks during mitral valve replacement, including ventricular rupture.
- Mitral valve repair techniques have historically been avoided in patients with severe MAC.
Purpose of the Study:
- To evaluate the safety and efficacy of mitral valve repair in patients with extensively calcified mitral annuli.
- To present outcomes of mitral valve repair following extensive decalcification of the mitral annulus.
Main Methods:
- Retrospective review of 12 patients undergoing mitral valve repair with decalcification between 1987-1990.
- Patients presented with varying degrees of mitral insufficiency and were in New York Heart Association (NYHA) functional classes II-IV.
- Outcomes assessed included mortality, reoperation, thromboembolic events, residual mitral insufficiency, and NYHA functional class.
Main Results:
- No deaths, reoperations, or thromboembolic events were reported in the study cohort.
- Postoperative echocardiography showed minimal residual mitral insufficiency in only 2 out of 12 patients.
- All patients improved to NYHA functional class I or II post-procedure.
Conclusions:
- Mitral valve repair is a viable and safe alternative to replacement in patients with extensively calcified mitral annuli.
- This technique effectively mitigates risks of ventricular rupture, thromboembolism, and hemorrhage linked to mitral valve replacement.
- Extensive decalcification followed by mitral valve repair offers favorable long-term outcomes for selected patients.
Abstract:
Mitral valve replacement in patients with an extensively calcified mitral annulus is associated with an increased risk of ventricular rupture. Until now techniques of mitral valve repair have not been applied to patients with a heavily calcified mitral valve annulus. We present 12 patients who underwent extensive decalcification of the annulus with subsequent mitral valve repair between 1987 and 1990. Ages ranged from 11 to 78 years; 6 patients were in New York Heart Association functional class II, 4 were in class III, and 2 were in class IV. All patients had varying degrees of mitral insufficiency. There were no deaths, reoperations, or thromboembolic events. Postoperative echocardiography revealed minimal residual mitral insufficiency in only 2 of 12 patients. All patients are currently in New York Heart Association class I or II. We believe mitral valve repair can be done safely on patients with an extensively calcified mitral annulus, thus avoiding the risks of left ventricular rupture, thromboembolic events, and hemorrhagic complications associated with mitral valve replacement.