El-Eshmawi Ahmed, Halas Monika, Bethea Brian T, David Tirone E, Grossi Eugene A, Guerrero Mayra, Kapadia Samir R, Melnitchouk Serguei, Mick Stephanie L, Quintana Eduard, Romano Matthew A, Tang Gilbert H L, Unai Shinya, Ghanta Ravi K
Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2025 Aug;170(2):502-522. doi: 10.1016/j.jtcvs.2025.04.003. Epub 2025 May 3.
Surgery for mitral valve disease in patients with mitral annular calcification (MAC) remains challenging. There is no consensus on the ideal management strategy or patient selection, and perioperative and periprocedural morbidity and mortality rates remain high. The recent surge of patients presenting with MAC has been accompanied by increased interest in MAC surgery and interventions. This expert consensus document is meant to provide a simplified outline for managing MAC, including patient selection, imaging, and surgical and transcatheter therapeutic options, with a particular focus on conventional surgical techniques and hybrid approaches.
The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international panel of cardiac surgeons and structural heart interventionalists with established expertise in the field of MAC. A comprehensive literature review was performed by the panel and a medical librarian. Clinical recommendations were developed utilizing a modified Delphi method.
Expert consensus was reached on 33 recommendations, with class of recommendation and level of evidence, for each of 5 main topics: (1) preoperative evaluation for patients with MAC, patient selection, and indications for intervention; (2) standard surgical techniques in MAC; (3) hybrid procedures in MAC; (4) transcatheter MAC interventions; and (5) complications and bailout of MAC surgery and interventions.
Despite the complexity and heterogenicity of patients presenting with MAC, consensus on several key recommendations was reached by this American Association for Thoracic Surgery expert panel. These recommendations provide guidance for cardiac surgeons and structural heart interventionists in treating most patients who present with MAC.
二尖瓣环钙化（MAC）患者的二尖瓣疾病手术仍然具有挑战性。对于理想的管理策略或患者选择尚无共识，围手术期和围操作期的发病率和死亡率仍然很高。最近MAC患者数量的激增伴随着对MAC手术和干预措施兴趣的增加。本专家共识文件旨在提供一个简化的MAC管理概述，包括患者选择、成像以及手术和经导管治疗选择，特别关注传统手术技术和混合方法。
美国胸外科协会临床实践标准委员会召集了一个由在MAC领域具有既定专业知识的心脏外科医生和结构性心脏介入专家组成的国际小组。该小组和一名医学图书馆员进行了全面的文献综述。利用改良的德尔菲法制定临床建议。
就5个主要主题中的每一个主题的33条建议达成了专家共识，包括建议类别和证据水平：（1）MAC患者的术前评估、患者选择和干预指征；（2）MAC的标准手术技术；（3）MAC的混合手术；（4）经导管MAC干预；（5）MAC手术和干预的并发症及补救措施。
尽管MAC患者情况复杂且具有异质性，但美国胸外科协会专家小组就若干关键建议达成了共识。这些建议为心脏外科医生和结构性心脏介入专家治疗大多数MAC患者提供了指导。
