Why the study?
Surgery for mitral valve disease with mitral annular calcification (MAC) is challenging with high morbidity and mortality, and lacks consensus on ideal management strategies and patient selection.
This AATS expert consensus document provides 33 recommendations to guide cardiac surgeons and structural heart interventionists in the complex management of patients with mitral annular calcification.
Guides clinical management of mitral annular calcification now; extends standardized framework for surgical and transcatheter research.
OBJECTIVE: Surgery for mitral valve disease in patients with mitral annular calcification (MAC) remains challenging. There is no consensus on the ideal management strategy or patient selection, and perioperative and periprocedural morbidity and mortality rates remain high. The recent surge of patients presenting with MAC has been accompanied by increased interest in MAC surgery and interventions. This expert consensus document is meant to provide a simplified outline for managing MAC, including patient selection, imaging, and surgical and transcatheter therapeutic options, with a particular focus on conventional surgical techniques and hybrid approaches. METHODS: The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international panel of cardiac surgeons and structural heart interventionalists with established expertise in the field of MAC. A comprehensive literature review was performed by the panel and a medical librarian. Clinical recommendations were developed utilizing a modified Delphi method. RESULTS: Expert consensus was reached on 33 recommendations, with class of recommendation and level of evidence, for each of 5 main topics: (1) preoperative evaluation for patients with MAC, patient selection, and indications for intervention; (2) standard surgical techniques in MAC; (3) hybrid procedures in MAC; (4) transcatheter MAC interventions; and (5) complications and bailout of MAC surgery and interventions. CONCLUSIONS: Despite the complexity and heterogenicity of patients presenting with MAC, consensus on several key recommendations was reached by this American Association for Thoracic Surgery expert panel. These recommendations provide guidance for cardiac surgeons and structural heart interventionists in treating most patients who present with MAC.
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El‐Eshmawi et al. (2025) conducted a review in Mitral annular calcification. Surgical and transcatheter management of mitral annular calcification was evaluated on Expert consensus recommendations. An expert panel reached consensus on 33 recommendations for the surgical, hybrid, and transcatheter management of mitral annular calcification.
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