Carol W. Chen1, Andrew M. Acker1, Jennifer J. Chung1, Ann C. Gaffey1, W. Clark Hargrove1, Michael A.Acker1, Pavan Atluri1,21Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
2Electronic correspondence: email@example.com
Background and aim of the study: Mitral annular calcification (MAC) is a complex degenerative process that complicates traditional mitral valve surgery due to concerns of atrioventricular groove disruption, paravalvular leak, and valve dehiscence. It is hypothesized that, with appropriate surgical techniques, traditional open mitral valve procedures can be performed in such cases with minimal morbidity and mortality, thereby affording the benefits associated with curative surgery to this patient cohort.
Methods: An examination was made of the operative course of patients who underwent mitral valve surgery at a single institution between 2010 and 2015. Patients with concomitant valve or aortic surgery were excluded. Significant MAC was defined as moderate or severe disease by echocardiography, and corroborated with operative findings. Patients with significant MAC were compared to those without MAC.
Results: Of 1,630 patients who underwent mitral valve surgery alone, 287 had MAC and 1,076 were without MAC.
Within the MAC cohort, 145 had significant disease. Compared to MAC-free patients, those with significant MAC were older, predominantly female, and had more comorbidities. Despite the slightly longer aortic cross-clamp time for patients with significant MAC, the rate of postoperative transfusions and complications were not different between groups; the 30-day mortality was also equivalent. Multivariate analysis showed that significant MAC was not an independent risk factor for 30-day mortality, when controlling for significant baseline characteristics.
Conclusion: Mitral valve surgery can be safely performed in patients with significant MAC, without inordinate mortality. Robust and durable treatment of mitral valve pathology with traditional open techniques should not be compromised for palliative interventions.Presented at the 2017 American Association for Thoracic Surgery Mitral Conclave, 27th-28th April 2017, New York, USA
The Journal of Heart Valve Disease 2015;24:66-71
|Mitral Valve Surgery is Safe in the Presence of Significant Annular Calcification|
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