Ultrasonic Emulsification of Severe Mitral Annular Calcification During Mitral Valve Replacement

Brescia, Alexander A.; Rosenbloom, Liza M; Watt, Tessa M.F.; Bergquist, Curtis S.; Williams, Aaron M.; Murray, Shannon L; Markey, Grace E.; Pagani, Francis D.; Ailawadi, Gorav; Bolling, Steven F.; Romano, Matthew A.

doi:10.1016/j.athoracsur.2021.11.066

Cited by 14 publications

(10 citation statements)

References 10 publications

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“…4 In that series, median hospital length of stay, mean gradient at last echocardiogram, and rate of reoperation did not differ by group. 4…”

Section: Discussionmentioning

confidence: 63%

“…An early report from Brescia et al in 15 patients who underwent MVR with emulsification of MAC using the Sonopet device demonstrated 0% mortality and 0% stroke in comparison with the non-MAC emulsification group, with rates of 10% and 17%, respectively, although there were no significant differences between the groups when accounting for the total historical series of MVR with MAC. 4 In that series, median hospital length of stay, mean gradient at last echocardiogram, and rate of reoperation did not differ by group. 4 This case demonstrates the utility of MAC ultrasonic emulsification and aspiration to enable successful MVr in a patient with severe MAC.…”

Section: Discussionmentioning

confidence: 63%

“…[1][2][3][4] Treatment of mitral disease with MAC is challenging, often requiring mitral valve replacement (MVR). 4 Mitral annular decalcification to enable mitral valve repair (MVr) requires preserving leaflet integrity and sufficient calcium debulking to enable annular remodeling and unrestricted leaflet motion without disrupting the atrioventricular groove. Care must be exercised to ensure that calcium fragmentation and debridement are associated with minimal embolic risks.…”

Section: Introductionmentioning

confidence: 99%

“…Mitral annular calcification (MAC) increases surgical complexity and is associated with increased perioperative risks. [1][2][3][4] Treatment of mitral disease with MAC is challenging, often requiring mitral valve replacement (MVR). 4 Mitral annular decalcification to enable mitral valve repair (MVr) requires preserving leaflet integrity and sufficient calcium debulking to enable annular remodeling and unrestricted leaflet motion without disrupting the atrioventricular groove.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonic Emulsification of Severe Mitral Annular Calcification to Enable Mitral Valve Repair

Fakim,

Cervetti,

Nagpal

et al. 2024

Innovations�(Phila)

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“…4 In that series, median hospital length of stay, mean gradient at last echocardiogram, and rate of reoperation did not differ by group. 4…”

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ultrasonic Emulsification of Severe Mitral Annular Calcification to Enable Mitral Valve Repair

Fakim,

Cervetti,

Nagpal

et al. 2024

Innovations�(Phila)

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“…4 Decalcification using an ultrasonic device has also been reported to be safe and effective using this approach. 11 This approach has the following potential risks: AV groove injury caused by valve stitches suturing through or behind the residual calcification and paravalvular leakage caused by inadequate seating of the mitral prosthesis on the stiff annulus.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of mitral valve replacement with complete annular decalcification

Numaguchi,

Takaki,

Nishigawa

et al. 2023

Asian Cardiovasc Thorac Ann

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Background This study aimed to examine the clinical outcomes of mitral valve replacement (MVR) in patients with severe mitral annular calcification (MAC) who required extensive decalcification and mitral annular reconstruction. Methods We reviewed 15 patients with severe MAC who underwent MVR between January 2016 and May 2022. In all cases, the calcified mitral annulus was resected completely using a Cavitron Ultrasound Surgical Aspirator, and a new annulus was created using bovine pericardium. In the acute postoperative phase, strict afterload reduction therapy using an intra-aortic balloon pump (IABP) was administered. Results The mean age of patients was 73 ± 8 years, and 13 (86.7%) were women. Concomitant aortic valve replacement was performed in 11 (73.3%) patients, tricuspid annuloplasty in 9 (60.0%), coronary artery bypass grafting in 1 (6.7%), and arrhythmia surgery in 7 (46.7%). The mean aortic cross-clamp and cardiopulmonary bypass times were 143 ± 32 min and 175 ± 34 min, respectively. In 13 patients, an IABP was used for 2 or 3 days postoperatively. There were no in-hospital deaths, left ventricular ruptures, or other MAC-related complications. Postoperative echocardiography revealed no paravalvular leakages. Conclusion Our strategy for managing severe MAC is safe and reproducible even in relatively high-risk patients. Afterload reduction using an IABP in the acute postoperative phase may reduce the risk of fatal complications after extensive decalcification and mitral annular reconstruction.

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Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI Registry

Kato,

Tabata,

Noguchi

et al. 2024

ESC Heart Failure

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AimsMitral stenosis (MS) occasionally coexists with aortic stenosis (AS). Limited data are available regarding the functional class and clinical outcomes of patients who undergo transcatheter aortic valve implantation (TAVI) for combined AS and MS. This study compared the clinical outcomes in patients with and without MS who underwent TAVI for severe AS and assessed the impact of mitral annulus calcification (MAC) severity, transmitral gradient (TMG) and mitral valve area (MVA) on outcomes in patients with combined AS and MS.MethodsWe investigated patients in the OCEAN‐TAVI registry who underwent TAVI. MS was defined as an MVA ≤ 1.5 cm2 or TMG ≥ 5 mmHg. The composite of all‐cause death and admission for heart failure was compared between patients with and without MS. The impact of MAC, TMG and MVA on outcomes was assessed in patients with combined AS and MS.ResultsWe identified 106 patients with MS (MAC 84%; TMG 6.4 ± 2.6 mmHg; MVA 1.10 ± 0.31 cm2) and 6570 without MS as controls. The MS group was older (85 ± 5 vs. 84 ± 5 years, P = 0.033), more of women (85 vs. 67%, P < 0.01), and had a higher risk of surgery (the Society of Thoracic Surgeons Mortality Score 8.7 ± 5.1 vs. 7.6 ± 5.9, P = 0.047) than the controls. In the MS group, the New York Heart Association Functional Class was 3 or 4 in 56% of the patients at baseline and 6% at 1 year after TAVI. Thirty‐day mortality (2.8% vs. 1.3%, P = 0.18) and early composite outcomes (17% vs. 15%, P = 0.56) were comparable between patients with and without MS. During a median follow‐up of 2.1 years, the presence of MS was associated with a higher incidence of adverse events compared with controls (adjusted hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.34–2.51, P < 0.01), even on propensity score matched analysis (adjusted HR 1.91; 95% CI 1.14–3.22, P < 0.01). Moderate or severe MAC contributed to increased risk of adverse events in patients with MS (adjusted HR 2.89; 95% CI 1.20–6.99, P = 0.018), but TMG and MVA did not.ConclusionsIn patients undergoing TAVI for severe AS, those with moderate or severe MS experienced worse outcomes after TAVI compared with those without MS. Patients with combined AS and MS sustained symptom improvement at 1‐year post‐TAVI. MAC severity was a useful predictor of adverse events compared with MS haemodynamics such as TMG and MVA in patients with combined AS and MS.

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Ultrasonic Emulsification of Severe Mitral Annular Calcification During Mitral Valve Replacement

Cited by 14 publications

References 10 publications

Ultrasonic Emulsification of Severe Mitral Annular Calcification to Enable Mitral Valve Repair

Ultrasonic Emulsification of Severe Mitral Annular Calcification to Enable Mitral Valve Repair

Outcomes of mitral valve replacement with complete annular decalcification

Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI Registry

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