Key result
Mitral valve repair without decalcification using a PTFE felt strip for partial annuloplasty resulted in trivial to no mitral regurgitation at 5-year follow-up in three patients with heavy MAC.
Why the study?
Mitral valve surgery can be challenging in patients with mitral annular calcification, with standard options carrying risks such as extensive reconstruction or paravalvular leak.
Does a novel repair technique without decalcification improve mitral regurgitation in patients with mitral valve prolapse and posterior annular calcification?
Case Report (n=3)
Does a novel repair technique without decalcification improve mitral regurgitation in patients with mitral valve prolapse and posterior annular calcification?
A novel mitral valve repair technique using a PTFE felt strip for partial annuloplasty without decalcification resulted in trivial to no mitral regurgitation at 5 years in three patients with posterior mitral annular calcification.
May support valve replacement without decalcification in select MAC cases; leaves open need for prospective validation before broader adoption.
BACKGROUND: Mitral valve surgery can be challenging for patients with mitral annular calcification (MAC). The prevalence of MAC in patients who undergo mitral valve replacement is 19.9%. The treatment options for MAC include complete decalcification and annular reconstruction with valve repair/replacement or performing a surgical valve repair or replacement without decalcification, accepting the risk of paravalvular leak. We describe three cases of mitral valve prolapse with posterior annular calcification, which were repaired using a unique technique that does not require decalcification. CASE REPORTS: The mitral annular calcification was heavy and involved most of the posterior annulus just sparing the commissures in all the three cases. Leaflet prolapse was dealt with by using neochordae, closing any clefts, and leaflet plication. Since the MAC ring was not complete and there was chance of further dilatation of the annulus, a partial annuloplasty was done using a PTFE felt (cut as strip). There was trivial to no mitral regurgitation with this technique in the immediate postoperative and five-year follow-up period echocardiography in all the three cases. CONCLUSION: This technique can benefit the major subset of pure mitral valve regurgitant lesions associated with MAC, which is limited to the posterior annulus.
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Panicker et al. (2020) conducted a case report in Mitral valve prolapse with posterior annular calcification (n=3). Mitral valve repair without decalcification using partial annuloplasty with a PTFE felt strip was evaluated on Mitral regurgitation in the immediate postoperative and five-year follow-up period. Mitral valve repair without decalcification using a PTFE felt strip for partial annuloplasty resulted in trivial to no mitral regurgitation at 5-year follow-up in three patients with heavy MAC.
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