Joel Price1, David Glineur2, Laurent De Kerchove2, Gebrine El Khoury2
1Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA, 2Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Univérsite Catholique de Louvain, Brussels, Belgium
Background and aim of the study: Mitral annular calcification (MAC) represents a significant challenge in mitral valve (MV) surgery. Techniques to decalcify the mitral annulus significantly increase operative complexity and risk. MV repair can be particularly difficult in this setting. Mid-term outcomes following MV surgery with extensive annular decalcification were examined, with attention focused on the feasibility and outcomes of MV repair in this setting.
Methods: Among 1,485 patients undergoing MV surgery between 1999 and 2008 at the authors’ institutions, 24 (1.6%) underwent complete posterior MV annular decalcification associated with either MV repair (n = 19) or replacement (n = 5). Extensive decalcification was performed from commissure to commissure in all patients. The annulus was reconstructed with pledgeted compression sutures in 17 patients, and with a bovine pericardial patch in seven.
Results: In-hospital mortality was 12.5%. One patient died
in the operating room from atrioventricular groove rupture, and two patients died from low cardiac output postoperatively. During a mean follow up of 4.4 ± 2.7 years, eight patients died; five of these deaths were cardiovascular in nature. After five years the actuarial survival was 56 ± 11%, and freedom from cardiac death 63 ± 11%. Four patients underwent reoperation because of failure of MV repair (n = 2), endocarditis (n = 1) or hemolysis (n = 1). All survivors were in NYHA class ≤2, with none to trivial mitral regurgitation in all MV repairs. The five-year freedom from MV reoperation was 82 ± 8%.
Conclusion: After aggressive decalcification of the posterior MV annulus, both MV repair and replacement were feasible, with acceptable procedure-related mortality. It was clear however, that decalcification increased both complexity and risk. In well-selected patients, an aggressive approach to MV repair might facilitate a high rate of repair with acceptable midterm outcome in this patient population.
The Journal of Heart Valve Disease 2015;24:46-52
|Mitral Valve Repair is Feasible Following Extensive Decalcification and Reconstruction of the Atrioventricular Groove|
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