Shi William Y, Mohan Navyatha, Sundt Thoralf M, Butte Sophie, Bloom Jordan P, Langer Nathaniel B, Melnitchouk Serguei I
Division of Cardiac Surgery, Department of Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg Short Rep. 2022 Aug 18;1(1):34-39. doi: 10.1016/j.atssr.2022.08.002. eCollection 2023 Mar.
Mitral annular calcification (MAC) in mitral valve surgery constitutes a major challenge. Debridement with patch reconstruction of the mitral annulus facilitates valve repair or replacement, however, there is a perception that this procedure may elevate operative risk. This study sought to review a single-center experience with mitral annular debridement and patch reconstruction in patients with MAC.
Data were collected on patients operated on from January 2017 to December 2020 in the setting of significant MAC. Patients underwent a systematic approach to MAC excision, involving complete removal of the entire calcium bar. This was followed by patch reconstruction of the debridement area before either valve repair or replacement.
The investigators identified 38 patients (24 female, 12 male) whose median age was 72 years (interquartile range, 62-80 years). There were 14 mitral valve repairs and 24 replacements. Twenty-five patients underwent a concomitant cardiac procedure. Seven cases were redo sternotomies. There were 2 (5%) 30-day mortalities. Median length of intensive care unit stay was 2.4 days, and median hospital stay was 8.5 days. One patient required postoperative extracorporeal support. There were 4 late deaths. Actuarial survival at 1 and 2 years was 89% and 82%, respectively. No patient has required reoperation for valvular dysfunction.
A systematic approach to MAC debridement, involving excision of the entire calcium bar and annular reconstruction, can be used in patients undergoing either isolated or combined complex mitral valve surgery. This strategy can be performed with a low risk of perioperative mortality despite relatively longer operative times.
二尖瓣手术中的二尖瓣环钙化（MAC）是一项重大挑战。二尖瓣环清创并进行补片重建有助于瓣膜修复或置换，然而，人们认为该手术可能会增加手术风险。本研究旨在回顾单中心对MAC患者进行二尖瓣环清创和补片重建的经验。
收集2017年1月至2020年12月期间因严重MAC接受手术的患者的数据。患者接受了系统性的MAC切除方法，包括完全切除整个钙条。然后在进行瓣膜修复或置换之前，对清创区域进行补片重建。
研究人员确定了38例患者（24例女性，12例男性），中位年龄为72岁（四分位间距为62 - 80岁）。其中14例进行了二尖瓣修复，24例进行了置换。25例患者同时进行了心脏手术。7例为再次胸骨切开术。有2例（5%）30天死亡率。重症监护病房中位住院时间为2.4天，医院中位住院时间为8.5天。1例患者术后需要体外支持。有4例晚期死亡。1年和2年的精算生存率分别为89%和82%。没有患者因瓣膜功能障碍需要再次手术。
一种系统性的MAC清创方法，包括切除整个钙条和环重建，可用于接受单纯或联合复杂二尖瓣手术的患者。尽管手术时间相对较长，但该策略可在围手术期死亡率较低的情况下实施。
