Complete Excision of Mitral Annular Calcification Can Be Achieved With a Low Mortality Risk

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Surgery
• Mitral Valve Disease

Background:

• Mitral annular calcification (MAC) presents significant challenges in mitral valve surgery.
• Debridement and patch reconstruction of the mitral annulus are employed for valve repair or replacement.
• Concerns exist regarding the potential elevation of operative risk with these procedures.

Purpose of the Study:

• To review the single-center experience with mitral annular debridement and patch reconstruction in patients with MAC.
• To evaluate the safety and efficacy of this surgical approach.

Main Methods:

• A systematic approach to MAC excision, including complete removal of the calcium bar.
• Patch reconstruction of the debrided area followed by mitral valve repair or replacement.
• Data collected from January 2017 to December 2020 for patients with significant MAC.

Main Results:

• 38 patients (median age 72 years) underwent the procedure, with 14 repairs and 24 replacements.
• Low 30-day mortality (2/38, 5%) and favorable median ICU (2.4 days) and hospital (8.5 days) stays.
• Actuarial survival at 1 and 2 years was 89% and 82%, respectively, with no reoperations for valvular dysfunction.

Conclusions:

• Systematic MAC debridement and annular reconstruction is feasible for complex mitral valve surgery.
• This strategy can be performed with low perioperative mortality, despite potentially longer operative times.
• The approach facilitates valve repair or replacement in challenging MAC cases.