Contemporary Surgical and Transcatheter Management of Mitral Annular Calcification

Double-layer horizontal cross sutures for intra-atrial mitral valve implantation: An effective surgical method for severe mitral annular calcification

“… 1 , 2 Over the past 40 years, various surgical procedures have been developed to address MAC. 3 These methods largely fall into 2 categories: “resect” or “respect” strategies, which are determined by the handling of the calcified annulus. 4 , 5 The “resect” strategy involves annular decalcification followed by annular reconstruction, whereas the “respect” strategy avoids extensive annular dissections.…”

Current techniques for severe mitral annular calcification

“… 4 However, there is no universally accepted approach to surgically address MAC. 5 As such, various approaches have been employed to address MAC, including complete resection of all calcifications with annular reconstruction, partial resection with removal of enough calcium to adequately seat a bioprosthetic valve, and transcatheter valve-in-MAC approaches. 6 However, as recognition and referral for MAC disease continues to grow, re-evaluation and incorporation of new techniques and technology to address MAC are necessary.…”

Commentary: Another tool in the toolbox for managing mitral annular calcification

“…When treating the MV with repair/replacement in the setting of MAC, the goal is to achieve leaflet coaptation and secure an annuloplasty, or accomplish complete replacement, without atrioventricular dissociation, annular disruption, or paravalvular leak (PVL). 3 Multiple surgical techniques have been described for the management of MAC, including complete decalcification, incomplete decalcification, and complete decalcification with preemptive annular reconstruction techniques with a Dacron or pericardial patch. With the trend in lithotripsy in coronary revascularization and peripheral artery disease, some speculate lithotripsy or ultrasound could be used to disrupt calcium to facilitate suture placement without disturbing the fibrous cap over MAC; work in this space is hypothesis-generating at this juncture.…”