P. D. Patel1, M. Broadwin1, A. Makkinejad3, S. Toledo1, J. K. Wu2 1Lehigh Valley Health Network, Department Of Surgery, Allentown, PA, USA 2Lehigh Valley Health Network, Department Of Cardiothoracic Surgery, Allentown, PA, USA 3University Of South Florida College Of Medicine, Tampa, FL, USA
Introduction: Severe mitral calcification poses a challenge during mitral valve replacement and confers a higher risk of complication if the calcium is not debrided adequately. Inadequate debridement and subsequent valve placement places the patient at increased risk for paravalvular leaks and valve dehiscence. Currently, manual debridement is a commonly used technique but can lead to injury which can be difficult to repair and thus, leading to a higher risk of mortality. This study aims to demonstrate the success of the ultrasonic aspirator to excise calcification during mitral valve replacement while also investigating variables which alter the success rate of these procedures.
Methods: A retrospective chart review was completed on 26 patients with mitral annular calcification (MAC) requiring ultrasonic aspirator use prior to mitral valve replacement (MVR). This is a single center study performed by multiple surgeons. Patient data was collected from September 2020 to August 2022 via electronic medical record system.
Results: The average age of the patient population was 72 years old. Most patients were female (65%, n=17), 27% (n=7) had diabetes, and 11% (n=3) were on hemodialysis at the time of procedure. In-hospital mortality rate was noted to be 7.6% (n=2) and an additional patient was reported deceased within 20 days of unknown cause. In-hospital complications included pleural effusion requiring drainage (n=2) and persistent atrial arrythmia requiring cardioversion (n=2). Of the complications reported, none were related to debris from mitral valve or mitral valve repair. No patient suffered a stroke post-operatively and there were no intraoperative complications noted. Factors which conferred to a higher rate of 30-day post-operative mortality were concurrent aortic stenosis requiring aortic valve replacement and decrease in ejection fraction post-operatively (n=2, average decrease 33%). Severity of mitral calcification, severity of mitral valve stenosis, and degree of mitral regurgitation did not correlate with a higher risk of complication peri or post-operatively.
Conclusion: Severe annular calcification of valves and leaflets pose a difficult challenge during valve replacement and can lead to various complications. The ultrasonic aspirator allows surgeons to successfully debride calcium in a controlled fashion, conferring a higher success rate for valve replacement and a lower rate of intra-operative complications.