Current and evolving strategies in the management of severe mitral annular calcification

Abstract

Proposed algorithm to address severe MAC during mitral valve surgery. Central Message Severe MAC is a complex problem that requires an armamentarium of tools. The cardiac surgeon of this era should be facile with multiple methods to manage patients with severe MAC. Perspective Severe MAC poses challenges that lack a consensus solution. We review the current and evolving strategies to address severe MAC during mitral valve surgery.

Contemporary Reoperative Mitral Valve Surgery: Technical Considerations and Clinical Outcomes

“…For cases with significant mitral annular calcification (MAC), some groups have found the cavitron ultrasonic surgical aspirator to be particularly useful. 37,38 With this instrument, a very accurate and localized calcium debridement can be achieved (Fig. 3).…”

Taming of the Tiger: A Novel Technique to Deal With Mitral Annular Calcification —A Case Series

“…The challenge with MAC is in mounting the annuloplasty ring. Leaflet-based repairs without a ring are simple, but results can vary [Bedeir 2018].…”

“…It is limited to the posterior annulus sparing the commissures in 90% of the cases [Carpentier 1996]. Mitral valve surgery in patients with MAC can be risky even in the most experienced hands, and it can result in a higher mortality [Bedeir 2018]. MAC usually occurs in older patients and more often in women.…”

Commentary: Robotic approach to mitral annular calcification—Are we doing more with less, or is less still more?

“…The mechanism of MAC is multifactorial, and its presence is seen in as many as 20% of patients undergoing MV surgery. 3,4 Robotic MV repair has been shown to be durable and cost neutral to sternotomy, with excellent 1-year outcomes in an all-comers approach, including patients with MAC. 5 Once the learning curve of robotic MV repair surgery has been crested, and the operative team is duly experienced, many advanced centers now regularly apply robotic techniques to essentially all pathoanatomic presentations.…”