El-Eshmawi Ahmed, Tang Gilbert H L, Sun Erick, Alexis Sophia L, Cangut Busra, Pandis Dimosthenis, Boateng Percy, Adams David H
Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY.
JTCVS Tech. 2023 Oct 20;22:1-12. doi: 10.1016/j.xjtc.2023.10.009. eCollection 2023 Dec.
Mitral annular calcification remains a formidable lesion in cardiac surgery with significant perioperative morbidity and mortality, particularly when en bloc annular decalcification is implemented. Respect strategies and hybrid approaches have provided safe alternatives. We report the short-term results of our institution's experience with mitral valve replacement in patients with extensive annular calcification.
This is a retrospective review of 72 consecutive patients with extensive annular calcification who underwent open surgical mitral valve replacement from January 1, 2013, to September 31, 2022. Degree of annular calcification was graded as partial, horseshoe, or circumferential. We excluded patients with calcification involving less than one-third of the annulus and patients with rheumatic heart disease.
Mean patient age was 71.6 ± 10.9 years, and 50 (69.4%) were female. There were 51 patients (70.8%) with New York Heart Association class 3 or greater and 47 patients (65.3%) with pulmonary hypertension. There were 41 patients (56.9%) with partial, 12 patients (16.7%) with horseshoe, and 19 patients (26.4%) with circumferential calcification. Fifty-six patients (77.8%) underwent conventional valve replacement. Sixteen patients underwent a hybrid procedure using balloon-expandable devices. Concomitant procedures were performed in 61 patients (84.7%). In-hospital mortality and 1-year survival were 3.57% and 82.8% in the standard valve replacement cohort and 25.0% and 54.7% in the hybrid cohort, respectively.
Conventional mitral valve replacement using respect strategies is safe and associated with good outcomes in patients with extensive annular calcification. Hybrid approaches using novel devices should remain as a bailout in select patients because of higher perioperative risks and poor short-term outcomes.
二尖瓣环钙化在心脏外科手术中仍然是一个棘手的病变，围手术期发病率和死亡率显著，尤其是在进行整块瓣环脱钙时。保留策略和杂交手术方法提供了安全的替代方案。我们报告了本机构对广泛瓣环钙化患者进行二尖瓣置换术的短期结果。
这是一项对2013年1月1日至2022年9月31日期间连续72例接受开放性二尖瓣置换术的广泛瓣环钙化患者的回顾性研究。瓣环钙化程度分为部分性、马蹄形或环形。我们排除了钙化累及瓣环不到三分之一的患者和风湿性心脏病患者。
患者平均年龄为71.6±10.9岁，50例（69.4%）为女性。51例（70.8%）患者纽约心脏协会心功能分级为3级或更高，47例（65.3%）患者患有肺动脉高压。41例（56.9%）患者为部分性钙化，12例（16.7%）患者为马蹄形钙化，19例（26.4%）患者为环形钙化。56例（77.8%）患者接受了传统瓣膜置换术。16例患者接受了使用球囊扩张装置的杂交手术。61例（84.7%）患者进行了同期手术。标准瓣膜置换组的住院死亡率和1年生存率分别为3.57%和82.8%，杂交组分别为25.0%和54.7%。
对于广泛瓣环钙化的患者，采用保留策略进行传统二尖瓣置换术是安全的，且预后良好。由于围手术期风险较高和短期预后较差，使用新型装置的杂交手术方法应仅作为特定患者的补救措施。
