Short and Longterm Results After Prosthetic Mitral Valve Implantation in Patients with Severe Mitral Annulus Calcification

Background: Mitral annulus calcification (MAC) prevalence is 3-9% and is a known comorbidity associated with other valve diseases, AF and IHD. Mitral surgery in the presence of MAC is considered a complicated endeavor dealt with by decalcification and annular reconstruction techniques.

Objective: determine short and long term outcome of mitral valve replacement surgery in the presence of MAC. Operative mortality and survival time was documented as well as follow up echocardiographic parameters of the prosthetic valve.

Methods: a subgroup of patients undergoing MVR surgery between 2004 and 2015, were found to have MAC. Patients with MAC underwent decalcification, posterior pericardial patch, circular annuloplasty or focal reinforcement of annulus. Echocardiogram was preformed routinely at the follow up period.

Results: out of 1031 MVR surgeries 126 were found to have MAC. Seven patients were referred for a re-MVR and 12 cases were urgent. Prosthetic valve implants were 22-35mm with 73% either 27mm or 29mm (59 and 34 respectively). 67% of prosthetic valves implanted were biologic prosthesis. Operative mortality was 5.5%; median survival time was 7.1 years ± 0.85. Follow echocardiogram of the Mitral valve showed 17 trivial, 9 mild and 1 moderate cases of regurgitation. No mitral stenosis was documented. There were 2 cases of paravalvular leak, one had trivial leak and one needed re-MVR.

Conclusion: MVR in the present of MAC is a more complicated endeavor and higher mortality rate may be expected in this subgroup of patients, nevertheless good long term results can be achieved.