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J Thorac Cardiovasc Surg 2003;126:777-781
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Mitral valve surgery in patients with extensive calcification of the mitral annulus

^a Division of Cardiovascular Surgery of Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada

Read at the Twenty-eighth Annual Meeting of The Western Thoracic Surgical Association, Big Sky, Mont, June 19-22, 2002.

Received for publication July 10, 2002; revisions received September 3, 2002; revisions received September 18, 2002; accepted for publication October 3, 2002.

^* Address for reprints: Dr Christopher M. Feindel, Peter Munk Cardiac Centre, Toronto General Hospital, 200 Elizabeth Street—14EN-205, Toronto, Ontario,Canada M5G 2C4
Chris.Feindel{at}UHN.on.ca

OBJECTIVES: The objective of this work was to examine the clinical outcomes of mitral valve surgery in patients with extensive mitral annular calcification.

METHODS: Mitral valve surgery was performed in 54 patients (28 men and 26 women, mean age 63 ± 14 years) with mitral regurgitation and extensive mitral annular calcification. Most patients (78%) were in New York Heart Association classes III and IV, 14 had coronary artery disease, and 9 had prior mitral valve replacement in which the calcium bar was not removed. The calcium bar was excised and a new mitral annulus was created by suturing a strip of pericardium onto the endocardium of the left ventricle from lateral to medial fibrous trigones and to the endocardium of the left atrium. The mitral valve was repaired in 12 patients and replaced in 42. In 23 patients the intervalvular fibrous body was reconstructed and the aortic valve was also replaced. Mean follow-up was 4.1 ± 3.7 years and was complete.

RESULTS: There were 5 operative deaths and 11 late deaths. Five-year survival was 73 ± 7%. Four patients needed reoperation and each survived. Freedom from reoperation at 5 years was 89 ± 6%. Three patients had a stroke and 4 had anticoagulation-related hemorrhage, one of which was fatal. Five-year freedom from valve-related mortality or morbidity was 75 ± 8%. Most survivors were in New York Heart Association functional classes II and III.

CONCLUSIONS: Resection of the calcium bar and creation of a new annulus with pericardium provided good clinical results in patients with extensive calcification of the mitral valve.