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High Mitral Annulus Calcium Score in Pre-Operative Chest Computerized Tomography and Adverse Outcomes in Mitral Valve
Alexandra Kasim1, Gabby Elbaz-Greener2,3, Amjad Shalabi4,5,6
1Department of Radiology, B Padeh Medical Center, Poriya, Israel.
Background:
Severe mitral annulus calcification (MAC) is believed to bear high operative and post-operative risk during mitral valve replacement (MVR) surgery, including longer surgery time, post-surgical valvular leaks and increased rate of embolic phenomena. We hypothesized that quantification of mitral calcium in pre-operative chest computerized tomography (CCT), performed to assess aortic root before cross-clamping may help in risk assessment of adverse intraoperative and postoperative outcomes in patients undergoing MVR.
Methods:
We included patients who underwent MVR between the years 2015 and 2018 at Poriya medical center. Preoperative CCT was performed using Philips iCT 256 and Agatston mitral annulus calcium score (MACS) was retrospectively calculated using Philips Intellispace portal version 8.0. Patients were divided into MACS quintiles; 1-3 quintiles were grouped (Low MACS) and compared to the 4-5 quintiles (High MACS) group for demographic, clinical operative and post-operative parameters.
Results:
A total of 66 patients had MVR, out of which 61% were males, with mean age of 64±9. Concomitant coronary or valvular procedures were done in 60% of patients. The median MACS was 43. High MACS (≥854) was not associated with longer bypass or cross clamp times. No differences in the MVR results were found between the groups. There were 6 post-operative embolic events; 1 mesenteric and 5 cerebral, which were not associated with MACS.
Conclusion:
MACS did not seem to be related to adverse outcomes in MVR. Due to a low event rate and probable pre-selection of patients without extreme mitral annulus calcifications our results should be confirmed in larger prospective study.
Insights
Mitral annulus calcification (MAC) quantification using pre-operative chest CT scans did not predict adverse outcomes in mitral valve replacement (MVR) surgery. Further studies are needed to confirm these findings in larger patient cohorts.
Area of Science:
- Cardiology
- Cardiac Surgery
- Radiology
Background:
- Severe mitral annulus calcification (MAC) poses risks in mitral valve replacement (MVR) surgery.
- These risks include longer surgery, valvular leaks, and embolic events.
- Pre-operative chest computerized tomography (CCT) may aid in assessing these risks.
Purpose of the Study:
- To evaluate if mitral annulus calcium score (MACS) from CCT can predict adverse outcomes in MVR patients.
- To assess the correlation between high MACS and intraoperative/postoperative complications.
Main Methods:
- Retrospective analysis of 66 MVR patients (2015-2018).
- Preoperative CCT used for Agatston MACS calculation.
- Patients grouped into Low MACS (quintiles 1-3) and High MACS (quintiles 4-5) for comparison.
Main Results:
- High MACS (≥854) was not linked to increased bypass or cross-clamp times.
- No significant differences in MVR outcomes were observed between low and high MACS groups.
- Postoperative embolic events (6 total) were not associated with MACS.
Conclusions:
- MACS does not appear to be a predictor of adverse outcomes in MVR.
- Low event rates and potential patient pre-selection necessitate larger prospective studies for confirmation.
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