Characterizing Risks Associated With Mitral Annular Calcification in Mitral Valve Replacement

Kaneko, Tsuyoshi; Hirji, Sameer; Percy, Edward; Aranki, Sary F.; McGurk, Siobhan; Body, Simon C.; Heydarpour, Mahyar; Mallidi, Hari R.; Singh, Somendra Pal; Pelletier, Marc; Rawn, James D.; Shekar, Prem

doi:10.1016/j.athoracsur.2019.04.080

Cited by 30 publications

(16 citation statements)

References 21 publications

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“…A recent analysis demonstrated that the presence of MAC alone, regardless of severity, was independently associated with increased operative mortality and adverse postoperative outcomes after surgical mitral valve replacement. 1 Parallel findings have been reported for transcatheter mitral valve replacement (TMVR) and severe MAC. 2 In this regard, the role of TMVR in MAC is still debated, given the worse mortality and widespread concerns regarding left ventricular outflow tract (LVOT) obstruction, paravalvular leak (PVL), embolization, and valve migration.…”

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confidence: 52%

Commentary: Trial and error—Is the transatrial approach the silver bullet for transcatheter mitral valve replacement in mitral annular calcification?

Hirji

Nguyen

2020

JTCVS Techniques

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Mitral annular calcification (MAC) poses a persistent diagnostic and management challenge in both the surgical and transcatheter landscape. A recent analysis demonstrated that the presence of MAC alone, regardless of severity, was independently associated with increased operative mortality and adverse postoperative outcomes after surgical mitral valve replacement. 1 Parallel findings have been reported for transcatheter mitral valve replacement (TMVR) and severe MAC. 2 In this regard, the role of TMVR in MAC is still debated, given the worse mortality and widespread concerns regarding left ventricular outflow tract (LVOT) obstruction, paravalvular leak (PVL), embolization, and valve migration. 2,3 These concerns, however, have been an impetus for clinicians to constantly challenge their technical horizons to chisel precisely, through trial and error, the silver bullet in terms of the most optimal TMVR access route.We read with interest the article by Vodstrup and colleagues 4 in this issue of the Journal. They describe a first-in-human case of transatrial TMVR with an inverted 23 Edwards Intuity Elite (Edwards Lifesciences, Irvine, Calif)

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confidence: 52%

Commentary: Trial and error—Is the transatrial approach the silver bullet for transcatheter mitral valve replacement in mitral annular calcification?

Hirji

Nguyen

2020

JTCVS Techniques

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“…Patients with MAC undergoing MVR have been shown to be independently associated with worse postoperative outcomes, including reoperation, postoperative morbidity, and operative mortality 20 than patients without MAC. MAC presents the cardiac surgeon with complex intraoperative decision making because there currently is no universally accepted surgical approach.…”

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confidence: 99%

Early outcomes of transatrial mitral valve replacement in severe mitral annular calcification

et al. 2021

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Objective: Mitral valve replacement (MVR) in the setting of severe mitral annular calcification is a technically challenging operation with increased morbidity and mortality. Transseptal/apical transcatheter MVR (TMVR) in mitral annular calcification has emerged as an option for these cases, although may not be feasible due to anatomical reasons. Transatrial TMVR is a potential treatment option for this subgroup of patients.Methods: Patients who underwent transatrial TMVR between June 2018 and November 2020 at a single institution were included. Patients were selected by a structural heart team based on their surgical risk, pattern of mitral annular calcification, risk of valve migration, left ventricular outflow obstruction, and paravalvular leak.Results: A total of 11 patients underwent transatrial TMVR. Mean patient age was 74.2 years and mean Society of Thoracic Surgeons predicted risk of mortality score was 9.1%. All patients had the presence of both mitral stenosis and regurgitationdominant etiology-was mitral stenosis in 81.2%, and mitral regurgitation in 18.8%. Among patients, 54.5% had a concomitant cardiac procedure. There was no in-hospital or 30-day mortality. Technical success defined by the Mitral Valve Academic Research Consortium was achieved in 90.9% of patients. Postoperative paravalvular leak was mild or less in all patients.Conclusions: In this series, transatrial TMVR was shown to be a safe and effective treatment option for patients who are high risk for surgical MVR and should be in surgeons' armamentarium in the treatment of this high-risk patient population. Dissemination of safe technique will be critical in the successful conduct of this surgery. (JTCVS Techniques 2021;-:1-8) Transatrial mitral valve replacement in a patient with mitral annular calcification.

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“…Выявлена зависимость между госпитальной летальностью и количеством выполняемых операцией. В клиниках, где выполняется менее 50 операций в год, был более высокий уровень госпитальной летальности [14]. Авторы связывают полученные результаты с высокой степенью исходной тяжести и сложностью операции.…”

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Immediate outcomes of treatment of severe mitral annular calcification

Муратов

Sorkomov

Sachkov

et al. 2021

RJTAO

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Mitral annular calcification (MAC) is a chronic degenerative process involving the fibrous part of the mitral complex, characterized by calcium deposition and loss of valve function. MAC prevalence is 8–10%, but despite this, the clinical significance of MAC is underestimated. Currently, there are reports that complete decalcification leads to improved long-term outcomes in patients with severe MAC. An analysis of the immediate outcomes of mitral valve surgery in patients with severely calcified mitral annulus with decalcification was performed. The calcified annulus fibrosus underwent complete decalcification in all cases. Calcium deposits were removed in a single block, in 6 cases it was reconstructed with a xeno-pericardial patch; in 2 cases the annulus fibrosus was sutured. There were 2 cases of in-hospital mortality, caused by acute heart failure on day 8 in 1 patient and pulmonary embolism on day 30 after operation in the second patient. There were no complications associated with coronary artery injury and left ventricular posterior wall rupture. Experience in the treatment of severe mitral valve calcification with extensive annulus fibrosus decalcification and subsequent reconstruction is possible and gives satisfactory results.

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Characterizing Risks Associated With Mitral Annular Calcification in Mitral Valve Replacement

Cited by 30 publications

References 21 publications

Commentary: Trial and error—Is the transatrial approach the silver bullet for transcatheter mitral valve replacement in mitral annular calcification?

Commentary: Trial and error—Is the transatrial approach the silver bullet for transcatheter mitral valve replacement in mitral annular calcification?

Early outcomes of transatrial mitral valve replacement in severe mitral annular calcification

Immediate outcomes of treatment of severe mitral annular calcification

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