Long-term clinical and echocardiographic outcomes after mitral valve surgery for severe mitral annular calcification

Objective To assess the long-term clinical and echocardiographic outcomes of mitral valve surgery with annular decalcification and pericardial patch reconstruction in patients with severe mitral annular calcification (MAC). Patients and methods Between 2012 and 2022, 112 consecutive high-risk patients (67 women, 45 men; mean age 66.5 ± 13.6 years) underwent surgery for severe MAC with mitral stenosis and/or regurgitation. Mitral valve repair was performed in 55 patients (49%) and replacement in 57 (51%). Concomitant procedures were performed in 65 patients (58%). Mean follow-up was 97 ± 48 months. Results Early mortality was 6.3% ( n = 7) and late mortality was 23.2% ( n = 26). Survival was 89.3%, 77.2%, and 64.1% at 60, 96, and 144 months, respectively. Freedom from reoperation was 98.3% at 60 months and 93.3% at 96 months. At follow-up, no surviving patient had more than grade III mitral regurgitation. Grade III regurgitation was present in 3 patients (4%), while no patient had grade IV regurgitation. Left atrial diameter, left ventricular end-diastolic diameter, and mean transvalvular gradient were significantly lower than before surgery. Conclusion In this high-risk cohort, annular decalcification and pericardial patch reconstruction provided durable valve function and acceptable long-term survival in patients who survived the perioperative period. Perioperative mortality, however, remained substantial.