Castillo-Sang Mario, Rios Matias, Wilkinson Tom, Khan Niem, Alam Masroor, Degrande Sean, Nayak Prashant
Department of Surgery, Division of Cardiac Surgery, St. Elizabeth Healthcare, Edgewood, KY, USA.
Sanatorio Finochietto, Buenos Aires, Argentina.
Innovations (Phila). 2025 Jul-Aug;20(4):397-405. doi: 10.1177/15569845251348207. Epub 2025 Jun 19.
Minimally invasive surgery for mitral annular calcification (MAC) has been reported sporadically, but data on endoscopic surgery are scarce. We summarize current surgical understanding of MAC and how it applies to endoscopic surgery through our experience.
All patients with severe MAC undergoing endoscopic mitral surgery at a single institution (December 2020 to August 2024) were studied.
Twenty-five patients (3 female patients) with an average left ventricular ejection fraction of 52.12% (46.25% to 60%), average age of 69.13 (64 to 75.7) years, average body surface area of 1.92 (1.69 to 2.09) m, and average Society of Thoracic Surgeons predicted risk of mortality score of 8.30% (2.13% to 8.66%) underwent endoscopic surgery. Twelve patients had regurgitation (48%), 10 had stenosis (48%), and 3 had a combination (12%). Circumferential MAC was found in 4 patients (16%), 80% circumference in 7 (28%), 60% circumference in 7 (28%), and 40% circumference in 7 (28%). Mitral valve replacement was done in 72% ( = 18) with tissue valves ( = 11), mechanical valves ( = 4), or transcatheter balloon-expandable valves ( = 3). Seven patients (28%) had repairs. There were no operative deaths, atrioventricular complications, or strokes. The average duration of surgery was 5 h 40 min (4 h 13 min to 8 h 22 min), with average cardiopulmonary bypass and cross-clamp times of 214 (166 to 241) min and 152 (117 to 193) min, respectively. MAC was debrided in 20 patients with ultrasonic emulsification ( = 13) or mechanical debridement ( = 7).
Endoscopic surgery for severe MAC can be safely and successfully performed using a combination of surgical techniques including ultrasonic decalcification, mechanical debridement, annular patching, and direct implantation of balloon-expandable valves.
二尖瓣环钙化（MAC）的微创手术已有零星报道，但内镜手术的数据稀缺。我们通过自身经验总结目前对MAC的手术认识及其在内镜手术中的应用。
对在单一机构（2020年12月至2024年8月）接受内镜二尖瓣手术的所有重度MAC患者进行研究。
25例患者（3例女性）接受了内镜手术，平均左心室射血分数为52.12%（46.25%至60%），平均年龄69.13岁（64至75.7岁），平均体表面积1.92（1.69至2.09）平方米，胸外科医师协会预测的平均死亡率风险评分为8.30%（2.13%至8.66%）。12例患者有反流（48%），10例有狭窄（48%），3例两者兼有（12%）。4例患者（16%）发现有环形MAC，7例（28%）为80%周长，7例（28%）为60%周长，7例（28%）为40%周长。72%（n = 18）的患者进行了二尖瓣置换，使用组织瓣膜（n = 11）、机械瓣膜（n = 4）或经导管球囊扩张瓣膜（n = 3）。7例患者（28%）进行了修复。无手术死亡、房室并发症或中风发生。平均手术时长为5小时40分钟（4小时13分钟至8小时22分钟），平均体外循环和主动脉阻断时间分别为214（166至241）分钟和152（117至193）分钟。20例患者的MAC通过超声乳化（n = 13）或机械清创（n = 7）进行了清除。
使用包括超声去钙化、机械清创、瓣环修补和直接植入球囊扩张瓣膜等手术技术的组合，可安全、成功地进行重度MAC的内镜手术。
