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Kareem Bedeir, MD, MS, Tsuyoshi Kaneko, MD, Sary Aranki, MD 

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Presentation on theme: "Kareem Bedeir, MD, MS, Tsuyoshi Kaneko, MD, Sary Aranki, MD "— Presentation transcript:

1 Current and evolving strategies in the management of severe mitral annular calcification 
Kareem Bedeir, MD, MS, Tsuyoshi Kaneko, MD, Sary Aranki, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 157, Issue 2, Pages (February 2019) DOI: /j.jtcvs Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Distribution prevalence of mitral annular calcification in the annular (A) and the vertical (B) planes. Adapted with permission from Carpentier et al.10 The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Cardiac computed tomography imaging and 3-D printing in mitral annular calcification (A and B): computed tomography imaging showing mitral annular calcium burden, distribution, and dimensions; (C) 3-D printing for surgical planning and management of various aortomitral angles, in anticipation of left ventricular outflow tract (LVOT) obstruction. AL, Anterior leaflet; PL, posterior leaflet; PVL, paravalvular leakage. Adapted with permission from Eleid et al.11 The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Reconstruction after significant posterior annular decalcification. A, Direct closure with figure-of-8 sutures (with less radical decalcification), (B) Carpentier's left atrial release technique, (C) David's pericardial patch technique, (D) Casselman's anterior mitral leaflet transposition. A and B, Adapted with permission from Carpentier et al10; (C) adapted with permission from Mihaljevic et al54; and (D) adapted with permission from Casselman et al.42 The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 “Respect” strategies with avoiding decalcification. A, Unconventional annuloplasty to avoid posterior annular sutures near the P1 and anterolateral commissure. B, Intra-annular implantation; plicating the posterior mitral leaflet. C, Combined intra and supra-annular implantation, with posterior leaflet and left atrial wall plication. D, Intra-annular implantation; valve prosthesis with supra-annular collar to compensate for paravalvular leakage. E, Intra-annular implantation; balloon-expandable sutureless melody valve under direct vision (view from the left atrium). A, Adapted with permission from Carpentier et al.55 B, Adapted with permission from Coselli et al.61 C, Adapted with permission from Di Stefano et al.62 D, Adapted with permission from Okita et al.63 E, Adapted with permission from El-Eshmawi et al.64 The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 Extra-anatomical techniques for addressing mitral stenosis associated with extensive mitral annular calcification. A, Left atrial dome to left ventricular apex using a midvalved conduit. B, Left atrial appendage to left ventricular apex with a terminally-valved conduit. A, Adapted with permission from Wright et al.69 B, Adapted with permission from Said et al.70 The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

7 Figure 6 Proposed approach to mitral valve intervention in nonfocal moderate to severe mitral annular calcification (MAC) with no prohibitive surgical risk. AML, Anterior mitral leaflet; MS, mitral stenosis; MR, mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

8 Proposed algorithm to address severe MAC during mitral valve surgery.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

9 Video 1 Authors summarizing the key points of this review addressing mitral interventions with severe mitral annular calcification. Video available at: The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

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