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Tips and tricks in addressing mitral annular calcification in mitral valve surgery

Malak Elbatarny1, Tirone E David1

  • 1Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, ON, Canada.

Annals of Cardiothoracic Surgery
|December 12, 2025
PubMed

Insights

Mitral annular calcification (MAC) presents surgical challenges for mitral valve (MV) repair and replacement. Careful planning and surgical technique are crucial for successful outcomes in these complex cases.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Disease
  • Medical Imaging

Background:

  • Mitral annular calcification (MAC) is a complex condition affecting mitral valve (MV) function.
  • MAC can significantly complicate surgical interventions for MV repair and replacement.
  • Surgical approaches for MAC vary widely depending on the extent of calcification.

Purpose of the Study:

  • To review surgical strategies for mitral valve dysfunction in patients with mitral annular calcification (MAC).
  • To outline preoperative planning, intraoperative techniques, and outcomes for MV surgery in MAC patients.
  • To discuss emerging experimental approaches for managing MAC.

Main Methods:

  • Review of surgical approaches for mitral valve (MV) patients with mitral annular calcification (MAC).
  • Discussion of preoperative assessment, patient selection, and detailed planning.
  • Highlighting intraoperative technical tips, potential challenges, and outcomes.
  • Inclusion of emerging hybrid and percutaneous techniques.

Main Results:

  • Surgical outcomes in MAC patients are contingent on avoiding technical difficulties related to anatomical challenges.
  • Extensive procedures like annular debridement and valve replacement may be necessary in some cases.
  • Careful preoperative assessment and planning are essential for optimizing surgical success.

Conclusions:

  • Mitral valve surgery in the presence of MAC requires meticulous planning and execution.
  • Successful outcomes depend on addressing the unique anatomical challenges posed by MAC.
  • Further research and development of innovative techniques are needed for this challenging patient population.
Keywords:
Mitral annular calcification (MAC)commando operationmitral annulus reconstructionmitral valve repairmitral valve replacement (MVR)

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