scholarly journals Taming of the Tiger: A Novel Technique to Deal With Mitral Annular Calcification —A Case Series

2020 ◽  
Vol 23 (6) ◽  
pp. E793-E796
Author(s):  
Varghese Panicker ◽  
Renjith Sreekantan ◽  
Sai Suraj Kotera
Keyword(s):  
Mitral Valve ◽  
Case Reports ◽  
Treatment Options ◽  
Case Series ◽  
Mitral Valve Surgery ◽  
Paravalvular Leak ◽  
Valve Repair ◽  
Mitral Annular Calcification ◽  
Annular Reconstruction ◽  
Annular Calcification

Background: Mitral valve surgery can be challenging for patients with mitral annular calcification (MAC). The prevalence of MAC in patients who undergo mitral valve replacement is 19.9%. The  treatment options for MAC include complete decalcification and annular reconstruction with valve repair/replacement or performing a surgical valve repair or replacement without decalcification, accepting the risk of paravalvular leak. We describe three cases of mitral valve prolapse with posterior annular calcification, which were repaired using a unique technique that does not require decalcification. Case reports: The mitral annular calcification was heavy and involved most of the posterior annulus just sparing the commissures in all the three cases. Leaflet prolapse was dealt with by using neochordae, closing any clefts, and leaflet plication. Since the MAC ring was not complete and there was chance of further dilatation of the annulus, a partial annuloplasty was done using a PTFE felt (cut as strip). There was trivial to no mitral regurgitation with this technique in the immediate postoperative and five-year follow-up period echocardiography in all the three cases. Conclusion: This technique can benefit the major subset of pure mitral valve regurgitant lesions associated with MAC, which is limited to the posterior annulus.

Advanced experience allows robotic mitral valve repair in the presence of extensive mitral annular calcification

2021 ◽  
Vol 161 (1) ◽  
pp. 80-88 ◽  
Author(s):  
Didier F. Loulmet ◽  
Neel K. Ranganath ◽  
Siyamek Neragi-Miandoab ◽  
Michael S. Koeckert ◽  
Aubrey C. Galloway ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Mitral Annular Calcification ◽  
Advanced Experience ◽  
Annular Calcification

scholarly journals Mitral valve repair versus replacement with extensive annular calcification: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Massimo Baudo ◽  
Rocco Petruccelli ◽  
Claudio Muneretto
Keyword(s):  
Systematic Review ◽  
Mitral Valve ◽  
Meta Analysis ◽  
Univariate Analysis ◽  
Paravalvular Leak ◽  
Term Survival ◽  
Annular Reconstruction ◽  
Secondary Endpoints ◽  
Meta Regression ◽  
Annular Calcification

Background: Mitral annular calcification (MAC) represents an important risk factor in mitral valve (MV) surgery. Despite several procedures have been described, no surgical treatment of choice has been yet established. Materials and Methods: A systematic review of the literature and meta-analysis on patients undergoing MV surgery associated to MAC was performed. The meta-analysis primary endpoints were 30-day mortality and late overall and cardiac-related mortality. Secondary endpoints were early reintervention, re-exploration for bleeding, postoperative pacemaker implantation, cerebrovascular accident, atrioventricular groove rupture, acute myocardial infarction and late recurrences of mitral regurgitation (MR) or paravalvular leak and reintervention. Primary and secondary endpoints were also evaluated in the subgroup analysis between MV repair and replacement surgery. Meta-regression was used to analyze the influence of decalcification and annular reconstruction on endpoints. Results: Among 1429 papers, 25 papers studying 1327 patients were included. In the pooled analysis, the 30-day mortality event rate was 2.89% (95%Confidence Interval [CI], 1.48%-5.57%) and 7.72% (95%CI, 2.95%-18.71%) for MV repair and replacement respectively. At mid-term follow-up, MV repair revealed a significantly lower incidence rate (IR) of death compared to MV replacement (p=0.043), with a trend of higher reoperation IR compared to replacement (p=0.051) and a trend of higher recurrent MR2+ in MV repair (p=0.071). Annular reconstruction was associated with a significant increase in re-exploration for bleeding at univariate analysis, but not at the multivariate meta-regression. Conclusions: The current meta-analysis suggests that MV repair in MAC patients may provide better short and mid-term survival outcomes when compared to replacement.

scholarly journals Current Devices in TMVI and Their Limitations: Focus on Tendyne

2020 ◽  
Vol 7 ◽  
Author(s):  
Gry Dahle
Keyword(s):  
United States ◽  
Mitral Valve ◽  
Treatment Options ◽  
Mitral Valve Regurgitation ◽  
Paravalvular Leak ◽  
Western World ◽  
Transcatheter Aortic Valve ◽  
High Incidence ◽  
Valve Implantation ◽  
Annular Calcification

Mitral valve regurgitation (MR) has a high incidence in the western world, and mortality is high for untreated severe MR. Catheter based repair was introduced with MitraClip in 2003, and some additional devices later came into the market. To expand the transcatheter treatment options for mitral valve disease, the first transcatheter mitral valve implantation (TMVI) was performed by Søndergaard et al. 2012, only 10 years after the first transcatheter aortic valve implantation (TAVI), however, the development has been much slower for the TMVI than for TAVI. From 2012, studies were started for several devices to prove feasibility and safety. However, there were big challenges in valve design; delivery systems and anchoring in addition to anatomical issues (avoid LVOT obstruction and paravalvular leak, big size of annulus). The main valves in studies were CardiaQ (later bought by Edwards Lifesciences, Irvine, United States), Tiara (Neovasc Inc., Richmond, Canada), Twelve (later Intrepid, Medtronic, MN, United States) and Tendyne™ (Abbott, MN, United States). I will focus on the Tendyne™ valve that is the only CE approved transcatheter mitral valve implant. It is available in a large number of sizes and is repositionable and retrievable. The results for the 100 first patients included in the early feasibility study (EFS) at 1 and 2 years are promising. Initially feasible for MR, but further investigations show promising results also for implant in mitral annular calcification.

scholarly journals Pre-procedural predictors for multiple clips in percutaneous edge-to-edge mitral valve repair

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Mohammad El Garhy ◽  
Bernward Lauer ◽  
Björn Göbel ◽  
Lisa C. Costello-Boerrigter ◽  
Carsten Salomon ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Atrial ◽  
Single Group ◽  
Valve Repair ◽  
Mitral Annular Calcification ◽  
Demographic Differences ◽  
Vena Contracta ◽  
Group I ◽  
Group Ii ◽  
Annular Calcification

Abstract Background Percutaneous mitral valve (MV) clipping for mitral regurgitation (MR) revolutionized MV repair; however, valve anatomies and pathologies vary. Often multiple clips are required, and predicting this pre-procedurally would be useful. We evaluated pre-procedural predictors for multiple clips. Results We retrospectively analyzed 127 severe MR patients treated by mitral clipping between January 2011 and August 2018. Patients were grouped according to the use of a single (group I) or multiple clips (group II) and pre-procedure echocardiographs compared. No demographic differences existed except group II had more males (68.1%) than group I (48.3%). Mean left atrial diameter was larger in group II, 51 ± 9 mm, than group I, 48 ± 5 mm, p = 0.026. Mean mitral annular diameter differed: 34 ± 4mm (group II) versus 33 ± 3 mm (group I), p = 0.017. The vena contracta was broader in group II than group I (6.6 ± 1 mm vs. 6 ± 0.9 mm, p = 0.001). Severe mitral annular calcification occurred more in group I (36.2%) than group II (10.1%), p = 0.0001. On multivariate analysis, vena contracta width correlated positively with multiple clips (B 0.125, p = 0.013), but severe annular calcification correlated inversely (B − 0.35, p = 0.002). Conclusions Vena contracta width and severe annular calcification are factors to consider when planning MV clipping.

scholarly journals Immediate outcomes of treatment of severe mitral annular calcification

2021 ◽  
Vol 23 (2) ◽  
pp. 52-59
Author(s):  
R. M. Muratov ◽  
M. N. Sorcomov ◽  
A. S. Sachkov ◽  
S. I. Babenko ◽  
A. M. Sleptsova ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Annulus Fibrosus ◽  
Posterior Wall ◽  
Mitral Annulus ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Calcium Deposition ◽  
Mitral Annular Calcification ◽  
Valve Function ◽  
Annular Calcification

Mitral annular calcification (MAC) is a chronic degenerative process involving the fibrous part of the mitral complex, characterized by calcium deposition and loss of valve function. MAC prevalence is 8–10%, but despite this, the clinical significance of MAC is underestimated. Currently, there are reports that complete decalcification leads to improved long-term outcomes in patients with severe MAC. An analysis of the immediate outcomes of mitral valve surgery in patients with severely calcified mitral annulus with decalcification was performed. The calcified annulus fibrosus underwent complete decalcification in all cases. Calcium deposits were removed in a single block, in 6 cases it was reconstructed with a xeno-pericardial patch; in 2 cases the annulus fibrosus was sutured. There were 2 cases of in-hospital mortality, caused by acute heart failure on day 8 in 1 patient and pulmonary embolism on day 30 after operation in the second patient. There were no complications associated with coronary artery injury and left ventricular posterior wall rupture. Experience in the treatment of severe mitral valve calcification with extensive annulus fibrosus decalcification and subsequent reconstruction is possible and gives satisfactory results.

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