Mitral Valve Surgery in Patients With Severe Mitral Annular Calcification

Uchimuro, Tomoya; Fukui, Toshihiro; Shimizu, Atsushi; Takanashi, Shuichirou

doi:10.1016/j.athoracsur.2015.08.071

Cited by 65 publications

(47 citation statements)

References 27 publications

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“…Evaluation of annular calcification by echocardiography and/or CT can possibly help to assess the organic component and likelihood of MR improvement in this population. The presence of heavily calcified annulus also provides an additional technical challenge for patients considered for a surgical approach . Reporting and quantifying MAC is, therefore, important to select the best therapeutic option in those patients, and can identify patients more likely to spontaneously improve their MR grade.…”

Section: Discussionmentioning

confidence: 99%

Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement

et al. 2019

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Background Significant mitral regurgitation (MR) is associated with poorer outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Factors associated with MR improvement have not been studied thoroughly. Methods Retrospective analysis of consecutive patients treated with TAVR with more than mild MR at baseline. MR evolution was assessed at 1–3 and 6–12 months after intervention. MR severity and mechanisms were assessed by echocardiography. Mitral annulus calcification (MAC) was quantified using preoperative cardiac CT. Results From 674 consecutive TAVR recipients, 78 with more than mild MR had a 6–12 months follow‐up. Following TAVR, MR improved in 34 patients (43%), remained stable in 38 (49%) and worsened in 6 (8%). Patients with MR improvement had greater tenting area (141 ± 56 vs. 99 ± 40 mm2, P < 0.01), tenting height (7.2 ± 1.9 vs. 5.6 ± 1.9 mm, P < 0.01) and lower ejection fraction (43 ± 16 vs. 52 ± 14%, P = 0.01). MAC was frequent (87.7% of patients) and a trend in greater MAC was observed in patients without MR improvement (3560 ± 5587 vs. 2053 ± 2800, P = 0.16). In multivariable analysis, tenting area (OR per 10 mm2 increase: 1.012, 95% CI, 1.001–1.024 P = 0.039) and annulus calcifications associated with leaflet restriction (OR = 0.108, 95% CI, 0.012–0.956, P = 0.045) were independently associated with MR outcome after TAVR. Conclusion Larger mitral valve tenting area was associated with more improvement of MR after TAVR whereas extensive MAC associated with leaflet restriction was associated with less improvement. This may help in the clinical decision‐making process of TAVR candidates with concomitant MR.

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Section: Discussionmentioning

confidence: 99%

Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement

et al. 2019

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“…The use of pledgeted, noneverting mattress sutures and reinforcing the annulus with Teflon strips are reported. 61,62 Reoperation is recommended if diagnosed early postoperatively, if related to endocarditis, or if associated with hemolysis requiring repeated blood transfusions or symptoms. Transcatheter closure is feasible, but reports that confirm consistent efficiency are limited at present.…”

Section: Postoperative Outcomes Long-term Follow-up and Complicationsmentioning

confidence: 99%

Mitral Valve Replacement—Current and Future Perspectives

Merwe

Casselman

2017

Open�J Cardiovasc Surg

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The favorable outcomes achieved with modern mitral valve repair techniques redefined the role of mitral valve replacement. Various international databases report a significant decrease in replacement procedures performed compared with repairs, and contemporary guidelines limit the application of surgical mitral valve replacement to pathology in which durable repair is unlikely to be achieved. The progressive paradigm shift toward endoscopic and robotic mitral valve surgery is also paralleled by rapid developments in transcatheter devices, which is progressively expanding from experimental approaches to becoming clinical reality. This article outlines the current role and future perspectives of contemporary surgical mitral valve replacement within the context of mitral valve repair and the dynamic evolution of exciting transcatheter alternatives.

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“…Firstly, we must take care to protect circumflex artery in the atrioventicular (AV) groove (Figure 2b). Secondly, we have to keep in mind that decalcification at this level creates an AV defect 5,6 , which, if not repaired properly, results in catastrophic bleedeng afterwards. We reduced a possibility to entrap the circumflex artery by placing every single "U" stitch under direct vision.…”

Section: Discussionmentioning

confidence: 99%

Reconstructive surgery of an extremely calcified mitral valve in Barlow disease patient: A case report

et al. 2019

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Introduction. Mitral valve calcifications are frequent finding in Barlow disease. This is making mitral repair surgery even more demanding in already complex valve pathology. Case report. A fifty-five-year-old Barlow disease patient underwent a mitral repair surgery due to posterior leaflet prolapse at P2 level and extensive posterior leaflet and annular calcifications as well. The prolapsed scallop was resected, while P1 and P3 scallops were detached from the annulus. After complete posterior annulus decalcification, so formed the large atrio-ventricular defect was reconstructed with the autologous pericardial patch and double suture line technique. The P1 and P3 segments were reattached there by the sliding technique and sutured with no strain. Annuloplasty was performed with a saddle rigid ring No 36. The patient was discharged nine days after the surgery with just a trace of mitral regurgitation. Conclusion. Annular decalcification and reconstruction in the patients with calcified Barlow mitral disease is neccessary for safe and durable mitral valve surgical repair.

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Mitral Valve Surgery in Patients With Severe Mitral Annular Calcification

Abstract: In patients with severe mitral annular calcification undergoing mitral valve surgery, complete annular decalcification and reconstruction yields favorable outcomes.

Cited by 65 publications

References 27 publications

Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement

Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement

Mitral Valve Replacement—Current and Future Perspectives

Reconstructive surgery of an extremely calcified mitral valve in Barlow disease patient: A case report

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