Purpose: Severe mitral annulus calcification is believed bear high operative and post-operative risk during mitral valve surgery including longer surgery time, post-surgical valvular leaks and increased rate of embolic phenomena. We hypothesized that quantification of mitral calcium in pre-operative chest computerized tomography (CCT) done to assess aortic root before cross-clamping may help in risk assessment for adverse outcomes in patients undergoing mitral valve surgery.
Material & Methods: Patients included had mitral valve surgery between 6-2015 and 6-2018 at our institute. Preoperative CCT was done with Philips iCT 256 and Agtston mitral annulus calcium score (MACS) was retrospectively calculated using Philips Intellispace portal version 8.0. Patients were divided into MACS tertiles; 1-2 tertiles were grouped and compared to the 3rd tertile for demographic, clinical operative and post-operative parameters.
Results: 66 patients had mitral surgery (age 64±9years, 61% males). Most were hypertensive (71%), had hyperlipidemia (55%) and diabetes mellitus (41%). Concomitant coronary/valvular procedures were done in 60% of patients. MACS ranged between 0 and 14,564 (average 854±2139, median 43). High MACS (≥854) was not associated with longer bypass or cross clamp times. Mitral valve surgery results were similar. There were 4 post-operative suspected embolic events (2 mesenteric, 2 cerebral) – that were not associated with MACS.
Conclusion: MACS did not seem to be related to adverse outcomes in mitral surgery. Due to a low event rate and probable pre-selection of patients without extreme mitral annulus calcifications our results should be confirmed in larger prospective study.
