Related Experiment Video
Updated: Jul 7, 2025
08:12
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
1.6K
Contemporary surgical techniques for mitral valve replacement in extensive mitral annular calcification
Ahmed El-Eshmawi1, Gilbert H L Tang1, Erick Sun1
1Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY.
JTCVS Techniques
|December 28, 2023
Summary
Mitral annular calcification poses risks in surgery. Conventional mitral valve replacement is safe for extensive calcification, while hybrid approaches carry higher risks and are best reserved for select cases.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Interventional Cardiology
Background:
- Mitral annular calcification (MAC) presents significant surgical challenges, increasing perioperative risks.
- Traditional en bloc decalcification is associated with high morbidity and mortality.
- Respect strategies and hybrid techniques offer alternative management approaches.
Purpose of the Study:
- To evaluate the short-term outcomes of mitral valve replacement in patients with extensive MAC.
- To compare the safety and efficacy of conventional versus hybrid approaches for MAC management.
Main Methods:
- Retrospective review of 72 patients undergoing open surgical mitral valve replacement for extensive MAC.
- Classification of MAC into partial, horseshoe, or circumferential.
- Comparison of outcomes between conventional valve replacement and hybrid procedures.
Main Results:
- Conventional replacement showed 3.57% in-hospital mortality and 82.8% 1-year survival.
- Hybrid procedures had 25.0% in-hospital mortality and 54.7% 1-year survival.
- Extensive MAC was present in 70.8% of patients with NYHA class 3 or greater.
Conclusions:
- Conventional mitral valve replacement with respect strategies is a safe and effective option for extensive MAC.
- Hybrid approaches using novel devices are associated with higher perioperative risks and poorer short-term outcomes.
- Hybrid procedures should be considered a bailout option for select patients with extensive MAC.
