Ultrasonic Decalcification in Severe Mitral Annular Calcification or Calcification of the Aortomitral Continuity—Is a Minimally Invasive Approach Feasible?

Background: In valve surgery, mitral annular calcification (MAC) is known as a complex entity to master and is associated with specific complications and elevated mortality. Since this patient cohort often bears a high clinical and procedural risk, simplifying and reproducible techniques for successful, gentle decalcification are mandatory. Ultrasonic decalcification has been proposed as treatment option in MAC patients enabling minimally invasive approach. We evaluated feasibility.

Methods: From September 2022 to July 2023 we treated 5 patients with MAC in minimally invasive setting via anterolateral minithoracotomy with endoscopic 3D visualization and cannulation via femoral vessels. We used ultrasonic decalcification prior to valve replacement for cautious debulking of the mitral annulus. We performed a retrospective single center review with evaluation of perioperative and outcome data of these 5 patients.

Results: Two patients were female and three male. Mean age was 64.6 ± 10.26 years, mean EuroSCORE II was 1.3 ± 0.86%. Procedure time was 126 ± 9 minutes, cross clamp time 60.4 ± 15 minutes and time on cardiopulmonary bypass was 86 ± 14 minutes. Conversion to sternotomy or atrioventricular grove rupture did not occur. Mean days on intensive care unit were 2.4 ± 2.6 with 6 ± 6 hours on ventilator, total hospital stay was 9.4 ± 4.4 days. We did not observe stroke or seizure, rethoracotomy for bleeding or pacemaker dependency postoperatively. None of the patients died in hospital or at follow-up so far.

Conclusion: In our experience application of ultrasonic decalcification of MAC in a minimally invasive setting is feasible and reproducible. MAC may no longer be an indication for open surgery in selected patients. We observed excellent outcomes without severe adverse events and rapid recovery. Further evaluation with larger patient cohorts should follow.

 

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Artikel online veröffentlicht:
13. Februar 2024