Serkan Güme1, Veysel Başar2, Mehmed Yanartaş3

1Department of Cardiovascular Surgery, Batman Training and Research Hospital, Batman, Turkey
2Department of Cardiovascular Surgery, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
3Department of Cardiovascular Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey

Keywords: Mitral annular calcification; mitral valve replacement; paravalvular leak.


Introduction: Mitral annular calcification (MAC) is a chronic degenerative condition characterized by calcification of the fibrous tissue surrounding the mitral valve. Conditions such as prosthetic valve dehiscence and atrioventricular groove separation may occur in patients with MAC who undergo mitral valve replacement (MVR). The aim of this study was to investigate what measures can be taken in the intraoperative/postoperative period to reduce postoperative paravalvular leak (PVL) rates, complications, mortality and morbidity rates among patients with MAC undergoing MVR.

Patients and Methods: Patients with MAC undergoing MVR in our clinic between January 2014 and December 2017 were retrospectively analyzed. The patients were divided into two groups: patients undergoing MVR and tricuspid valve intervention (Group 1, n= 26, %56.5) and those undergoing MVR, tricuspid valve intervention and additional cardiac procedure (Group 2, n= 20, %43.4). Preoperative, operative and postoperative outcomes of them were compared.

Results: The study included a total of 46 patients, 16 males (34.8%) and 30 females (65.2%). The mean age of patients was 62 ± 11.6. The analysis of intraoperative data showed that cross-clamp time and cardiopulmonary bypass time in Group 2 were significantly longer than other group (p< 0.001). In the postoperative period, postoperative day 0 and total drainage amount, blood product requirement, development of postoperative acute kidney injury, hemodialysis/hemofiltration requirement, and need for extracorporeal membrane oxygenation (ECMO) and inotropic treatment were found to be significantly higher in Group 2. In the postoperative echocardiography data, no significant difference was found between the two groups in terms of PVL rates.

Conclusion: Cross-clamp time and cardiopulmonary bypass time were found to be higher in patients with MAC receiving both MVR and additional procedure compared to those who underwent MVR and more complications were observed in these patients. Additional surgical procedures did not affect paravalvular leak rates and mortality rates among the patients with MAC.

Ethics Committee Approval

This study was approved by Kartal Kosuyolu High Specialization Training and Research Hospital Ethics Committee (2018/2/55, Date: 23.02.2018).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept/Design - SG, VB, MY; Analysis/ Interpretation - SG; Data Collection - SG; Writing - SG; Critical Revision - VB, MY; Statistical Analysis - SG; Overall Responsibility - SG; Final Approval - All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.