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Characterizing Risks Associated With Mitral Annular Calcification in Mitral Valve Replacement
Tsuyoshi Kaneko1, Sameer Hirji1, Edward Percy1
1Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
The Annals of Thoracic Surgery
|June 18, 2019
Summary
Mitral annular calcification (MAC) increases operative mortality and adverse outcomes in mitral valve replacement (MVR) patients. Low-volume centers also show higher MVR mortality, highlighting the need for specialized care.
Area of Science:
- Cardiac Surgery
- Cardiovascular Research
- Health Services Research
Background:
- Mitral annular calcification (MAC) complicates mitral valve (MV) procedures.
- Assessing the impact of MAC on mitral valve replacement (MVR) outcomes is crucial for surgical planning.
Purpose of the Study:
- To evaluate the risks associated with MAC in patients undergoing MVR.
- To determine the influence of hospital MVR procedural volume on operative mortality.
Main Methods:
- Analysis of 52,816 MVR procedures from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2017).
- Comparison of operative mortality and complications between MAC and non-MAC patients.
- Assessment of hospital MV procedure volume's impact on adjusted operative mortality.
Main Results:
- MAC was present in 18.1% of MVR cases, associated with higher operative mortality (5.8% vs 4.4%).
- MAC increased risks of acute kidney injury and reintubation; stroke and reoperation rates were similar.
- Low-volume centers (<50 MV procedures/year) had higher operative mortality (OR, 1.21).
Conclusions:
- MAC is an independent risk factor for increased operative mortality and adverse postoperative outcomes after MVR.
- Hospital MV procedure volume significantly impacts MVR outcomes, with lower volumes linked to worse results.
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