Annals of cardiothoracic surgery最新文献

{"title":"Tips and tricks in addressing mitral annular calcification in mitral valve surgery.","authors":"Malak Elbatarny, Tirone E David","doi":"10.21037/acs-2025-mac-0136","DOIUrl":"10.21037/acs-2025-mac-0136","url":null,"abstract":"<p><p>Mitral annular calcification (MAC) is a heterogeneous condition that can complicate mitral valve (MV) repair and replacement operations. Surgery in the context of MAC varies considerably. Relatively simple repairs or replacements can be performed in several patients without the need to remove the calcium bar. However, extensive annular debridement, reconstruction of the atrioventricular junction, reconstruction of the intervalvular fibrous body, and mitral and aortic valve replacement may be necessary in some instances. Outcomes of these patients are directly related to the avoidance of technical problems amid a variety of potential anatomic challenges and pitfalls. Careful preoperative assessment, patient selection, detailed preoperative planning, and intraoperative judgment are required to optimize the chance of a successful outcome. Here we describe our approach to the MV patients with MAC, including preoperative planning, intraoperative technical tips and tricks, as well as a discussion of outcomes and remaining questions in this challenging population. This review only includes patients with MAC and MV dysfunction. It excludes those with associated aortic valve disease. The article contains a lecture on MV surgery in patients with MAC. We also highlight emerging experimental approaches, including hybrid and percutaneous techniques.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"452-461"},"PeriodicalIF":3.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical approach to mitral annular calcification-the Cleveland Clinic experience.","authors":"Haley Jenkins, Haytham Elgharably, Shinya Unai, Gosta Pettersson, Marc Gillinov","doi":"10.21037/acs-2025-mac-0117","DOIUrl":"10.21037/acs-2025-mac-0117","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"491-493"},"PeriodicalIF":3.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral valve surgery in mitral annular calcification.","authors":"Martin Misfeld, Tristan D Yan","doi":"10.21037/acs-2025-1-65-mac","DOIUrl":"10.21037/acs-2025-1-65-mac","url":null,"abstract":"<p><p>Mitral annular calcification (MAC) remains a challenging pathology in the context of mitral valve disease. It is associated with known cardiovascular risk factors, as well as a variety of chronic inflammatory, infective, or connective tissue diseases. Surgically, patients are at specific operative risk for atrioventricular dehiscence or rupture and/or injury to the circumflex artery. To mitigate these risks, a broad portfolio of surgical options exists to safely anchor annular sutures. This can be performed after the calcium bar has been removed and the posterior annulus reconstructed with a patch, or even when the calcium bar is left in place. Knowledge of these techniques will help surgeons manage MAC and implant a properly sized valve. Even in the presence of severe MAC with additional involvement of the mitral valve leaflets, transatrial transcatheter heart valve (THV) implantation may be a viable option. An individualized decision-making process to determine the applicable technique should be used for patients with MAC, leading to adequate treatment for this high-risk patient group.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"496-503"},"PeriodicalIF":4.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic posterior bar decalcification and mitral repair in mitral annular calcification.","authors":"Didier F Loulmet, Ali Hage, Eugene A Grossi","doi":"10.21037/acs-2025-mac-19","DOIUrl":"10.21037/acs-2025-mac-19","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"514-516"},"PeriodicalIF":3.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future of transcatheter versus surgery for mitral annular calcification.","authors":"Gorav Ailawadi","doi":"10.21037/acs-2025-mac-0195","DOIUrl":"https://doi.org/10.21037/acs-2025-mac-0195","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"494-495"},"PeriodicalIF":3.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic mitral valve repair in the setting of mitral annular calcification.","authors":"Taylor Pickering, Cody W Dorton, Ely Erez, Lee Hafen, Robert L Smith","doi":"10.21037/acs-2025-mac-0127","DOIUrl":"10.21037/acs-2025-mac-0127","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"511-513"},"PeriodicalIF":4.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and mid-term outcomes of mitral annular calcification and transcatheter mitral therapy: a systematic review.","authors":"Yosuke Sakurai, Ashton McDonald, Tsuyoshi Kaneko","doi":"10.21037/acs-2025-mac-0128","DOIUrl":"10.21037/acs-2025-mac-0128","url":null,"abstract":"<p><strong>Background: </strong>Mitral annular calcification (MAC) poses technical and clinical challenges in patients undergoing mitral valve intervention. Patients with severe MAC were excluded from major previous randomized controlled trials evaluating mitral therapies. Consequently, outcomes following mitral transcatheter edge-to-edge repair (M-TEER) in this population remain controversial.</p><p><strong>Methods: </strong>MEDLINE and EMBASE were searched through June 2025 to identify studies reporting outcomes after M-TEER in patients with MAC. This systematic review assessed the difference in MAC grading and M-TEER eligibility across studies. The definition of procedural success was documented to highlight inconsistencies. The primary endpoint was all-cause mortality during follow-up. Secondary endpoints included procedural success, heart failure rehospitalization, mitral valve reintervention, residual mitral regurgitation (MR), and mean mitral gradient.</p><p><strong>Results: </strong>Six studies met inclusion criteria, including 2,808 patients undergoing M-TEER, of whom 363 (12.9%) had moderate-to-severe MAC. Most studies defined procedural success as MR reduction to grade ≤2, though only one incorporated a mean transmitral gradient <5 mmHg. MR reduction to ≤2 rates were comparable between patients with none-mild MAC and moderate-severe MAC. However, device success (MR reduction ≤2 and mean gradient <5 mmHg) was significantly lower in MAC patients (56.1% versus 81.3%). Post-procedural mitral valve gradient >5 mmHg occurred in 18.5-48.3% of MAC cases. Two studies reported increased all-cause mortality in patients with moderate-severe MAC during follow-up, with a mean follow-up of 20.4 months. Residual MR and reintervention rates were generally similar between groups, though mitral valve gradients tended to be higher in MAC patients.</p><p><strong>Conclusions: </strong>M-TEER is feasible in well-selected patients with moderate-to-severe MAC; however, elevated post-procedural gradients remain a concern and may impact long-term outcomes. The absence of standardized eligibility criteria for M-TEER and consistent MAC quantification limits optimal patient selection. Comparative studies with surgical repair/replacement and transcatheter mitral valve replacement are critically needed to define optimal therapy.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"395-406"},"PeriodicalIF":3.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasonic emulsification to facilitate mitral valve reconstruction in mitral annular calcification.","authors":"Mathieu Rheault-Henry, Mohsyn Imran Malik, Nitish Bhatt, Jill Gelinas, Michael W A Chu","doi":"10.21037/acs-2025-mac-0171","DOIUrl":"10.21037/acs-2025-mac-0171","url":null,"abstract":"<p><strong>Background: </strong>Mitral annular calcification (MAC) increases the complexity and risk of mitral valve surgery, often limiting repair feasibility. This study evaluates the early outcomes of ultrasonic emulsification and aspiration using a novel device to facilitate mitral valve repair.</p><p><strong>Methods: </strong>We conducted a prospective, single-centre, single-surgeon series of 27 consecutive patients with moderate-to-severe MAC and degenerative mitral regurgitation (MR) undergoing Sonopet-assisted decalcification between June 2023 and July 2025. Procedures were performed via median sternotomy or endoscopic mini-thoracotomy. Ultrasonic aspiration was used to remove and sculpt MAC, enabling annular remodelling and secure repair. The primary outcome was repair success and residual regurgitation; secondary outcomes included mortality and perioperative complications.</p><p><strong>Results: </strong>Mitral repair was successfully performed in 26 patients (96.3%), with one conversion to replacement. There were no in-hospital deaths, strokes, atrioventricular (AV) groove disruptions, or reoperations. At discharge, 96.3% had none or mild residual MR; one patient (3.7%) had moderate MR. Mean coaptation length was 10.3±3.2 mm. Postoperative complications included new-onset atrial fibrillation in five patients (18.5%) and permanent pacemaker implantation in two (7.4%). Sternotomy approach was used in 63% and endoscopic mini-thoracotomy in 37%. Mean cardiopulmonary bypass (CPB) and cross-clamp times were 159.6±46.8 and 116.9±46.5 min, respectively. Most mitral repairs addressed isolated posterior leaflet prolapse (66.7%) or bileaflet prolapse (22.2%). Primary repair strategies included leaflet resection (51.9%), isolated neochords (25.9%), or resection with neochords (22.2%). MAC decalcification was primarily performed in the posterior annulus.</p><p><strong>Conclusions: </strong>Ultrasonic emulsification is a safe, effective adjunct for mitral valve repair in moderate-to-severe MAC, enabling precise decalcification and high repair rates with minimal complications. This approach may expand repair candidacy and merits further comparative studies with long-term follow-up.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"482-490"},"PeriodicalIF":4.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of mitral annular calcification in mitral valve surgery: 25-year Mayo Clinic experience.","authors":"Arman Arghami, Behrooz Banivaheb, Hartzell V Schaff","doi":"10.21037/acs-2025-mac-0187","DOIUrl":"10.21037/acs-2025-mac-0187","url":null,"abstract":"<p><strong>Background: </strong>Annular calcification [mitral annular calcification (MAC)] may complicate mitral valve (MV) surgery, and long‑term outcome data are limited.</p><p><strong>Methods: </strong>We reviewed adult patients undergoing MV surgery at our Clinic between January 2000 and December 2024. MAC was identified on preoperative imaging, and operative strategy prioritized repair when feasible and employed conservative debridement when necessary. Patients with MAC were matched 1:1 with patients without MAC using a propensity score.</p><p><strong>Results: </strong>Among 11,350 MV operations with or without concomitant procedures, 1,603 patients (14.1%) had MAC, the median age was 72.6 years [interquartile range (IQR), 65.3-78.6 years], 54.8% were female. In the MAC cohort, 21% of patients had a prior sternotomy. Concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) were performed in 32% and 24% of cases, respectively. Compared with propensity-matched controls, MAC patients did not exhibit significantly prolonged cardiopulmonary bypass times (115 <i>vs.</i> 112 minutes, P=0.485) or aortic cross-clamp durations (86 <i>vs.</i> 81 minutes, P=0.273). The 30-day hospital readmission rate was significantly higher among MAC patients (15.9% <i>vs.</i> 9.9%, P<0.001). Although 30-day mortality was elevated in the MAC group (5.8% <i>vs.</i> 4.2%), the difference was not statistically significant (P=0.171). In a subgroup analysis of matched groups undergoing primary isolated MV surgery, early mortality was 2.7% in patients with MAC and 0.5% in patients without MAC (P=0.111). Long-term, 10-year survival was significantly lower in MAC patients (43.6%) compared to matched controls (49.6%, P<0.001).</p><p><strong>Conclusions: </strong>In this large single-center series, patients with MAC often had associated aortic valve and coronary artery disease, and 21% of them were undergoing a second procedure. Compared to matched patients without MAC, long-term survival was reduced in patients with MAC. This experience highlights the importance of accurate preoperative assessment and tailored surgical strategy to achieve acceptable outcomes of MV surgery in the presence of MAC.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"462-471"},"PeriodicalIF":3.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified mitral valve replacement technique using transcatheter aortic valve for severe mitral annular calcification.","authors":"Sujay Kulshrestha, Tsuyoshi Kaneko","doi":"10.21037/acs-2025-mac-0181","DOIUrl":"10.21037/acs-2025-mac-0181","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"517-519"},"PeriodicalIF":4.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}