title: Mitral Valve Surgery in Patients With Severe Mitral Annular Calcification.
abstract: BACKGROUND
  Mitral valve surgery in patients with severe mitral annular calcification can be challenging. We investigated surgical outcomes of mitral valve surgery with complete annular decalcification and reconstruction.
  
  
  METHODS
  Between January 2004 and December 2013, 2,104 patients underwent mitral valve surgery at our institution. Of these, 61 patients (mean age 70 years) with severe mitral annular calcification were reviewed. Valve lesions were stenosis in 20 patients (32.8%), regurgitation in 16 (26.2%), mixed in 19 (31.1%), and prosthetic valve dehiscence in 6 (9.8%). Calcified annulus was resected completely and reconstructed with equine pericardium in 48 patients (78.7%), autologous pericardium in 10 (16.4%), and polytetrafluoroethylene felt pledgets in 3 (4.9%). Mitral valve repair was attempted in 4 patients (6.6%) and mitral valve replacement in 57 (93.4%). One patient (1.6%) had conversion from repair to replacement due to cardiac rupture. Concomitant procedures included aortic valve replacement in 36 patients (56.3%), tricuspid valve surgery in 28 (43.8%), and coronary artery bypass graft surgery in 18 (28.1%). Mean follow-up was 3.5 ± 2.5 years.
  
  
  RESULTS
  There was no 30-day hospital death. Early complications were left ventricular pseudoaneurysm in 1 patient, pericardial patch dehiscence in 1, severe arrhythmia in 6, and stroke in 2. At 5 years, rates of survival and freedom from cardiac death and major adverse valve-related events were 75.6%, 79.7%, and 72.7%, respectively. Multivariate analysis indicated coronary artery disease as an independent predictor of cardiac death.
  
  
  CONCLUSIONS
  In patients with severe mitral annular calcification undergoing mitral valve surgery, complete annular decalcification and reconstruction yields favorable outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan. Electronic address: tmy-chmr@kkh.biglobe.ne.jp.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Uchimuro
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Shuichirou
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome