Outcomes of Valve Repair for Degenerative Disease in Patients With Mitral Annular Calcification

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Anton Tomšič1, Yasmine L Hiemstra2, Thomas J van Brakel1

  • 1Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.

The Annals of Thoracic Surgery
|October 9, 2018
PubMed
Abstract

Insights

Mitral annular calcification (MAC) in degenerative mitral valve disease surgery is safe. Optimal strategies include annular decalcification and ring annuloplasty for comparable outcomes, but addressing the annulus is crucial for repair durability.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Valvular Heart Disease

Background:

  • Degenerative mitral valve disease is a common condition requiring surgical intervention.
  • Mitral annular calcification (MAC) is a frequent finding in these patients, but its impact on surgical outcomes is not fully understood.

Purpose of the Study:

  • To evaluate the risk factors for MAC development in degenerative mitral valve disease.
  • To assess the effect of MAC on patient- and valve-related outcomes following mitral valve surgery.

Main Methods:

  • A retrospective analysis of 627 patients who underwent mitral valve operations for degenerative disease between 2002 and 2015.
  • Comparison of outcomes between patients with and without MAC, with specific attention to surgical techniques like annuloplasty ring implantation and annular decalcification.

Main Results:

  • MAC was present in 12% of patients and was associated with older age, female sex, and specific degenerative disease subtypes.
  • Early mortality was similar between groups, but early repair failure was more common in MAC patients (11% vs 3%).
  • While overall survival and late reintervention rates were comparable, freedom from recurrent mitral regurgitation was worse in MAC patients at 8 years, particularly if ring annuloplasty was not used.

Conclusions:

  • Mitral valve surgery for degenerative disease with MAC is safe when optimal surgical strategies are employed.
  • Annular decalcification and ring annuloplasty are recommended for patients with MAC to achieve outcomes similar to those without MAC.
  • Failure to address the calcified annulus can compromise repair performance, necessitating exploration of alternative repair techniques for these challenging cases.

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