Commentary: It is all about the skirt: Length and material

Abstract

Mitral valve replacement in the setting of severe mitral annular calcification (MAC) remains a surgical challenge. The fundamental concern with mitral valve replacement in the presence of MAC is decalcification required to pass the sutures through the mitral annulus, which can lead to annular disruption or perivalvular leak (PVL). Complex en bloc decalcification and reconstruction of the mitral annulus have been described.1,2 However, these procedures are technically challenging and only done by a few skillful surgeons, and as such they are not ready for widespread use.