Long-term clinical and echocardiographic outcomes after mitral valve surgery for severe mitral annular calcification

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe mitral annular calcification (MAC) with hemodynamically significant mitral stenosis and/or regurgitation (n=112). Intervention: Mitral valve surgery with en-bloc annular decalcification and pericardial patch reconstruction vs. Age- and sex-matched general population (external reference); mitral valve repair vs replacement (internal comparison). Primary outcome: Overall mortality during follow-up (p=0.0016).

Q: What does this research mean for the field?

Mitral valve surgery with annular decalcification and pericardial patch reconstruction for severe mitral annular calcification achieves durable valve function and acceptable long-term survival, though perioperative mortality remains substantial. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yoganiranjana Dharuman; Egan Leonidovich Kalmykov; Mirko Doss

doi:10.3389/fcvm.2026.1881651

October 28, 2026Frontiers in Cardiovascular MedicineOpen Access

Long-term clinical and echocardiographic outcomes after mitral valve surgery for severe mitral annular calcification

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Key result

Mitral surgery with annular reconstruction for severe MAC yields ~64% 12-year survival.

P=0.0016
n=112

Why the study?

The study aimed to assess the long-term clinical and echocardiographic outcomes of mitral valve surgery with annular decalcification and pericardial patch reconstruction in patients with severe mitral annular calcification.

Does mitral valve surgery with en-bloc annular decalcification and pericardial patch reconstruction provide durable valve function and acceptable long-term survival in high-risk patients with severe mitral annular calcification?

Study Design

Type

Cohort (n=112)

Multicenter

No

Structured PICO

Does mitral valve surgery with en-bloc annular decalcification and pericardial patch reconstruction provide durable valve function and acceptable long-term survival in high-risk patients with severe mitral annular calcification?

P

Population

112 high-risk adults (mean age 66.5 years, 60% female) with severe mitral annular calcification and hemodynamically significant mitral valve disease, excluding emergency/salvage or transcatheter procedures, followed for a mean of 97 months.

E

Exposure

Mitral valve surgery with en-bloc annular decalcification and pericardial patch reconstruction (autologous or bovine pericardium), followed by mitral valve repair (n=55, 49%) or replacement (n=57, 51%; biological n=38, mechanical n=19), with concomitant procedures performed in 65 patients (58%). Surgical approaches included full median sternotomy (71%), partial upper sternotomy (14%), and minimally invasive right anterolateral thoracotomy (14%).

C

Comparator

Age- and sex-matched general population (taken from the period life tables of the German Federal Statistical Office) for survival comparison; internal comparisons between mitral valve repair (n=55) and replacement (n=57).

O

Outcome

Early (30-day) and late mortality, long-term survival, freedom from reoperation, and long-term echocardiographic valve function over a mean follow-up of 97 ± 48 months (8 ± 4 years).hard clinical

Main Result

p-value: p=0.0016

In high-risk patients with severe mitral annular calcification, en-bloc annular decalcification and pericardial patch reconstruction yield durable long-term valve competence and survival comparable to the general population among those who survive a substantial perioperative risk (6.3% 30-day mortality).

Limitations

Retrospective single-centre design with 112 high-risk patients
Univariate analyses only (no multivariable Cox model fitted), so findings represent associations rather than independent predictors and residual confounding cannot be excluded
Long-term echocardiography was available for 72 of 79 survivors, introducing potential survivor bias
Comparison with the age- and sex-matched general population excluded perioperative mortality and therefore represents conditional survival
Surgical approaches (sternotomy vs minimally invasive) could not be compared without confounding by concomitant procedure type
Retrospective single-centre study design
Associations between preoperative variables and mortality were derived from univariate analyses rather than multivariable Cox models, so residual confounding cannot be excluded
Long-term echocardiography was available for 72 of the 79 survivors, introducing potential survivor bias
Comparison with the general population excluded perioperative mortality and represents conditional survival
Surgical approaches could not be compared without confounding by procedure type because concomitant procedures were performed almost exclusively through sternotomy and the minimally invasive subgroup was small

Implication

Supports durable outcomes with annular decalcification and patch reconstruction in severe MAC; leaves open randomized comparisons to alternatives.

Abstract

Objective To assess the long-term clinical and echocardiographic outcomes of mitral valve surgery with annular decalcification and pericardial patch reconstruction in patients with severe mitral annular calcification (MAC). Patients and methods Between 2012 and 2022, 112 consecutive high-risk patients (67 women, 45 men; mean age 66.5 ± 13.6 years) underwent surgery for severe MAC with mitral stenosis and/or regurgitation. Mitral valve repair was performed in 55 patients (49%) and replacement in 57 (51%). Concomitant procedures were performed in 65 patients (58%). Mean follow-up was 97 ± 48 months. Results Early mortality was 6.3% ( n = 7) and late mortality was 23.2% ( n = 26). Survival was 89.3%, 77.2%, and 64.1% at 60, 96, and 144 months, respectively. Freedom from reoperation was 98.3% at 60 months and 93.3% at 96 months. At follow-up, no surviving patient had more than grade III mitral regurgitation. Grade III regurgitation was present in 3 patients (4%), while no patient had grade IV regurgitation. Left atrial diameter, left ventricular end-diastolic diameter, and mean transvalvular gradient were significantly lower than before surgery. Conclusion In this high-risk cohort, annular decalcification and pericardial patch reconstruction provided durable valve function and acceptable long-term survival in patients who survived the perioperative period. Perioperative mortality, however, remained substantial.

Discussion

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Cite This Study

Dharuman et al. (2026) conducted a cohort in Severe mitral annular calcification (MAC) with hemodynamically significant mitral stenosis and/or regurgitation (n=112). Mitral valve surgery with en-bloc annular decalcification and pericardial patch reconstruction vs. Age- and sex-matched general population (external reference); mitral valve repair vs replacement (internal comparison) was evaluated on Overall mortality during follow-up (p=0.0016). Mitral valve surgery with annular decalcification and patch reconstruction for severe MAC resulted in 6.3% early mortality, 64.1% 12-year survival, and 93.3% 8-year freedom from reoperation.

synapsesocial.com/papers/6ae4339ed9418cd7c8f4681a https://doi.org/10.3389/fcvm.2026.1881651

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Long-term clinical and echocardiographic outcomes after mitral valve surgery for severe mitral annular calcification

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Long-term clinical and echocardiographic outcomes after mitral valve surgery for severe mitral annular calcification

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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