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Contemporary Surgical and Transcatheter Management of Mitral Annular Calcification

J James Edelman1, Vinay Badhwar2, Robert Larbalestier1

  • 1Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, Australia.

The Annals of Thoracic Surgery
|August 18, 2020
PubMed

Insights

Mitral annular calcification (MAC) complicates mitral valve (MV) disease management. This review covers surgical and transcatheter techniques for MAC, offering options for high-risk patients.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Mitral annular calcification (MAC) presents challenges in managing mitral valve (MV) stenosis or regurgitation.
  • Patients with MAC often have comorbidities, limiting surgical candidacy.
  • This review focuses on contemporary techniques for managing MAC during MV treatment.

Purpose of the Study:

  • To review the anatomy, pathology, and management of MAC in patients with severe MV disease.
  • To highlight current surgical and transcatheter techniques for MAC treatment.
  • To discuss the outcomes associated with various MAC management strategies.

Main Methods:

  • Focused review of existing literature on MAC.
  • Description of surgical approaches for MAC resection (en bloc vs. incomplete).
  • Evaluation of transcatheter techniques and their limitations in MAC patients.

Main Results:

  • MAC incidence ranges from 5% to 42% in severe MV disease.
  • Pathophysiology likely involves inflammation and atherosclerosis.
  • Transcatheter therapies face challenges like left ventricular outflow tract obstruction and paravalvular regurgitation.

Conclusions:

  • A range of techniques exists for managing MAC in severe MV disease.
  • Transcatheter therapies expand options for patients with high surgical risk.
Abstract

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