Unusual Complications During Mitral Valve Replacement in the Presence of Calcification of the Annulus

MacVaugh, Horace; Joyner, Claude R.; Johnson, Julian

doi:10.1016/s0003-4975(10)65459-8

Cited by 74 publications

(28 citation statements)

References 2 publications

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“…Mitral anular calcification remains a formidable technical challenge to the cardiac surgeon, as excessive debridement of heavy anular calcification carries a risk of cardiac rupture at the site of the atrioventricular groove and of the left ventricular wall, and ligation of the left circumflex coronary artery can result in a lowoutput state. 5 On the contrary, to decalcify the anulus completely is safer and easier than to implant a prosthesis using sutures passed through the calcified anulus. 6 Nevertheless, the latter technique has been performed in patients undergoing mitral valve repair chiefly for mitral regurgitation with less extensive calcification than our patient.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve replacement in a patients with an extensively calcified mitral anulus: Report of a case

et al. 1998

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We report herein the case of a patient with chronic renal failure in whom mitral valve stenosis with extensive mitral anular calcification involving the entire anulus and leaflets was successfully treated surgically. Excision of both leaflets and partial resection of the anular calcification enabled the insertion of a 23-mm St. Jude Medical prosthetic valve. The technical difficulties involved with inserting the appropriate-sized prosthetic valve in a narrowed mitral anulus with heavy calcification are discussed following this case report.

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Section: Discussionmentioning

confidence: 99%

Mitral valve replacement in a patients with an extensively calcified mitral anulus: Report of a case

et al. 1998

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“…MacVaugh et al 55 reported their experience of 5 cases among a total of 10 patients with posterior MAC in which MVR was complicated with intraoperative hemorrhage from the left ventricle. Besides these catastrophic complications, paravalvular leak is another important limitation of valve replacement in a severely calcified annulus.…”

Section: Managementmentioning

confidence: 99%

Degenerative Mitral Stenosis

et al. 2016

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Abstract-Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities and often are high-risk candidates for surgery. The mainstay of therapy in DMS patients is medical management with heart rate control and diuretic therapy. Surgical intervention might be delayed until symptoms are severely limiting and cannot be managed by medical therapy. Mitral valve surgery is also challenging in these patients because of the presence of extensive calcification. Hence, there is a need to develop an alternative percutaneous treatment approach for patients with DMS who are otherwise inoperable or at high risk for surgery. In this review, we summarize the available data on the epidemiology of DMS and diagnostic considerations and current treatment strategies for these patients.

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“…Bloom and Cashon described the calcified MV annulus back in 1945 [1]. It is estimated that the prevalence of MAC is between 3% and 9% in patients undergoing mitral valve replacement (MVR) [2][3][4][5][6]. MAC could be an incidental finding associated with ageing, possibly causing significant morbidity due to left ventricular inflow obstruction and symptomatic mitral stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…MVR in the presence of MAC is considered to be associated with worse surgical outcomes; its presence could sever fixation sutures of the mitral prosthesis, thus leading to paravalvular leak and clinical deterioration [6].…”

Section: Introductionmentioning

confidence: 99%

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Short- and long-term results after prosthetic mitral valve implantation in patients with severe mitral annulus calcification†

Ben-Avi

Orlov

Sternik

et al. 2017

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES: To investigate short-and long-term outcomes of a conservative decalcification approach in mitral valve replacement (MVR) surgery in the presence of mitral annulus calcification (MAC). METHODS:Of the 1038 patients who underwent MVR, 133 (13%) had significant MAC with at least 30% of the annular circumference heavily calcified. In most patients, the surgical approach to MAC included conservative decalcification, supra-annular prosthesis implantation and insertion of a pericardial patch between the MV annulus and the prosthesis. These patients were matched by a propensity score to a group of patients who underwent MVR without MAC (n = 118 in each group) and served as a control group.RESULTS: There were 6 early deaths in each group with an overall mortality of 5% (P = 0.90). Early complications included one major stroke in the non-MAC group and acute renal failure needing dialysis in 2 and 3 patients in the MAC and non-MAC groups, respectively. Mean follow-up was 55 ± 37 months and 99.1% complete. There were 38 (33%) and 33 (29%) late deaths with an estimated survival of 61% and 69% at 6 years in the MAC and non-MAC groups, respectively (P = 0.55). At follow-up, functional class did not differ between groups (P = 0.096). Mean echo follow-up time was 40 ± 35 months and was 83% complete. Freedom from moderate or severe mitral regurgitation was 95% and 98%, with an estimated freedom of 95% and 96% at 6 years (P = 0.20), and mean gradient was 4.9 ± 2.3 mmHg and 5.2 ± 2.0 mmHg for MAC and non-MAC groups, respectively (P = 0.58). CONCLUSIONS:A conservative approach for dealing with MAC is suitable for the majority of patients. Early and late clinical and echocardiographic outcomes did not differ between the MAC and non-MAC patients, including freedom from early and late occurrence of MV prosthesis paravalvular leak.

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Unusual Complications During Mitral Valve Replacement in the Presence of Calcification of the Annulus

Cited by 74 publications

References 2 publications

Mitral valve replacement in a patients with an extensively calcified mitral anulus: Report of a case

Mitral valve replacement in a patients with an extensively calcified mitral anulus: Report of a case

Degenerative Mitral Stenosis

Short- and long-term results after prosthetic mitral valve implantation in patients with severe mitral annulus calcification†

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