Abstract 4143450: Strong correlation between preoperative CT-reconstructions and postoperative samples in the assessment of mitral annular calcification: Validation of Calcium scores and MAC scores

Background: The surgical management of severe mitral annular calcification (MAC) has become an increasingly common challenge. Accurate preoperative prediction of the extent and location of calcification is crucial for preoperative planning, informed consent, and safe surgical management. Hypothesis: CT-derived calcium scores correlate with the Guerrero classification of MAC severity. Furthermore, CT reconstructions provide an accurate representation of calcifications observed in postoperative macroscopic specimens. Methods: Patients with preoperative CT imaging and MAC resection were included. Preoperative CT assessed MAC using Aquarius, TeraRecon software (V.4.7). Severity was graded based on calcium thickness, distribution, and involvement of leaflets and trigones according to the Guerrero classification. Calcium scores were quantified using the Agatston method, and MAC was 3D reconstructed. The relationship between calcium and MAC scores was assessed using Spearman's ρ. Additionally, qualitative comparisons were made between CT reconstructions and postoperative samples. Results: A total of 31 patients were analyzed, with a median age of 74. Two patients had mild MAC (mean calcium score: 2996), 14 had moderate MAC (mean calcium score: 6105), and 15 had severe MAC (mean calcium score: 9271). There was a strong positive correlation between preoperative calcium scores and Guerrero classification grades (Spearman's ρ = 0.65, p < 0.01). Qualitative assessment showed a high degree of similarity between preoperative CT reconstructions and postoperative macroscopic findings. Conclusions: The study demonstrates a strong correlation between preoperative CT-derived calcium scores and the Guerrero classification of MAC severity. However, the high degree of similarity between preoperative CT reconstructions and postoperative samples carries a higher informational value than the MAC score itself. Preoperative CT reconstructions of MAC, coupled with the calcium score as a surrogate for MAC volume and severity, provide the most accurate assessment of MAC for surgical planning and evaluation of alternatives. Further studies are required to determine preoperative criteria that predict safe MAC resections.