Severe Mitral Annular Calcification and Mitral Valve Surgery: An Algorithmic Approach to Management.

Alejandro Pizano, Sameer A Hirji, Tom C Nguyen

Journal: Seminars in thoracic and cardiovascular surgery 2021;32(4):630-634

PMID: 32464177

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Abstract

The management of mitral valve dysfunction in the setting of substantial mitral annular calcification (MAC) remains controversial and is one of the most challenging problems in mitral valve surgery. The physiopathology of severe MAC is related to a combination of progressive, degenerative and active calcium deposition in the annulus that is often multifactorial, but largely attributable to aging and chronic disease conditions. Given the fact that overall life expectancy in the elderly population are increasing, it is imperative to understand contemporary and future therapeutic options since this MAC is likely going to be a frequent problem faced by the next generation of cardiac surgeons. This review provides a relevant synthesis of existing literature and aims to assess the efficacy of existing therapeutic choices for patients with mitral valve dysfunction and 'big' MAC with a goal of minimizing postoperative complications (e.g. left ventricular outflow tract obstruction, prosthetic paravalvular leak, valve embolization, and stroke) that can be achieved via a multidisciplinary heart team approach.

Address: Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart and Vascular Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas. Electronic address: [email protected].; Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.; Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart and Vascular Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.

DOI: 10.1053/j.semtcvs.2020.05.021

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MeSH Terms: Algorithms, Calcinosis, Clinical Decision-Making, Decision Support Techniques, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Humans, Mitral Valve, Mitral Valve Annuloplasty, Mitral Valve Insufficiency, Mitral Valve Stenosis, Postoperative Complications, Recovery of Function, Risk Factors, Severity of Illness Index, Treatment Outcome