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The American Association for Thoracic Surgery (AATS) 2025 Expert Consensus Document: Surgical management of mitral

Ahmed E El-Eshmawi1, Monika Halas2, Brian T Bethea3

  • 1Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.

The Journal of Thoracic and Cardiovascular Surgery
|May 5, 2025
PubMed

Insights

Managing mitral annular calcification (MAC) surgery is complex. This expert consensus provides 33 recommendations for patient selection, surgical, and transcatheter interventions for MAC, improving treatment strategies.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Mitral annular calcification (MAC) presents significant challenges in mitral valve disease management.
  • High perioperative morbidity and mortality rates underscore the need for standardized approaches.
  • Increasing prevalence of MAC necessitates updated clinical guidelines.

Purpose of the Study:

  • To provide a simplified management outline for MAC.
  • To guide patient selection, imaging, and therapeutic options (surgical and transcatheter).
  • To focus on conventional surgical techniques and hybrid approaches for MAC.

Main Methods:

  • An international expert panel of cardiac surgeons and interventionalists was assembled.
  • A comprehensive literature review was conducted.
  • Clinical recommendations were developed using a modified Delphi method.

Main Results:

  • Consensus was achieved on 33 recommendations.
  • Recommendations cover preoperative evaluation, patient selection, surgical techniques, hybrid procedures, and transcatheter interventions for MAC.
  • Guidance is provided on managing complications and bailout strategies for MAC interventions.

Conclusions:

  • Consensus was reached on key recommendations for managing complex MAC patients.
  • The guidelines offer practical support for clinicians treating MAC.
  • These recommendations aim to improve outcomes for patients with MAC undergoing interventions.
Abstract

Keywords:
mitral annular calcificationmitral valve repairmitral valve replacement

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