Simple supra-annular prosthesis insertion for dialysis patients with extensive mitral annular calcification

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Nephrology

Background:

• Mitral annular calcification (MAC) predominantly affects the posterior annulus.
• Dialysis patients often present with extensive MAC and are at high risk for cardiac surgery.
• Standard mitral valve replacement can be challenging in these patients due to extensive calcification.

Purpose of the Study:

• To evaluate the safety and efficacy of a novel "half-and-half" supra-annular prosthesis insertion technique.
• To address the challenges of mitral valve replacement in dialysis patients with extensive MAC.
• To present an alternative surgical approach for high-risk patients with severe MAC.

Main Methods:

• A cohort of five dialysis-dependent patients with extensive MAC underwent mitral valve replacement (MVR) using the "half-and-half" technique.
• The technique involved supra-annular prosthesis insertion with mattress sutures anchored to the left atrial wall and the non-calcified anterior annulus.
• Minimum debridement of the calcified annulus was performed; anterior MAC removal was necessary in one patient requiring double valve replacement.

Main Results:

• No patient experienced valve dysfunction post-operatively.
• Four hospital survivors showed no valve-related events during follow-up (11-33 months).
• One patient had a trivial paravalvular leak, with no other complications reported.

Conclusions:

• The "half-and-half" supra-annular prosthesis insertion is a safe and straightforward technique for MVR in dialysis patients with extensive MAC.
• This method requires minimal debridement of the calcified annulus.
• The technique offers a promising alternative for high-risk surgical candidates with severe MAC, with St. Jude Medical valves being suitable.