Complete Excision of Mitral Annular Calcification Can Be Achieved With a Low Mortality Risk

Background: Mitral annular calcification (MAC) in mitral valve surgery constitutes a major challenge. Debridement with patch reconstruction of the mitral annulus facilitates valve repair or replacement, however, there is a perception that this procedure may elevate operative risk. This study sought to review a single-center experience with mitral annular debridement and patch reconstruction in patients with MAC. Methods: Data were collected on patients operated on from January 2017 to December 2020 in the setting of significant MAC. Patients underwent a systematic approach to MAC excision, involving complete removal of the entire calcium bar. This was followed by patch reconstruction of the debridement area before either valve repair or replacement. Results: The investigators identified 38 patients (24 female, 12 male) whose median age was 72 years (interquartile range, 62-80 years). There were 14 mitral valve repairs and 24 replacements. Twenty-five patients underwent a concomitant cardiac procedure. Seven cases were redo sternotomies. There were 2 (5%) 30-day mortalities. Median length of intensive care unit stay was 2.4 days, and median hospital stay was 8.5 days. One patient required postoperative extracorporeal support. There were 4 late deaths. Actuarial survival at 1 and 2 years was 89% and 82%, respectively. No patient has required reoperation for valvular dysfunction. Conclusions: A systematic approach to MAC debridement, involving excision of the entire calcium bar and annular reconstruction, can be used in patients undergoing either isolated or combined complex mitral valve surgery. This strategy can be performed with a low risk of perioperative mortality despite relatively longer operative times.