Mitral valve replacement in the presence of massive calcification

Abstract

I was pleasantly surprised to read the novel technique reported by Hussain and colleagues.1Hussain S.T. Idrees J. Brozzi N.A. Blackstone E.H. Pettersson G.B. Use of annulus washer after debridement: a new mitral valve replacement technique for patients with severe mitral annular calcification.J Thorac Cardiovasc Surg. 2013; 145: 1672-1674Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar I reported on the technique used at the All India Institute of Medical sciences way back in 1988,2Sampathkumar A.S. Massive mitral and myocardial calcification—technical manoeuvers for successful valve replacement.Int J Cardiol. 1988; 20: 279-282Abstract Full Text PDF PubMed Scopus (4) Google Scholar which my group used when confronted with a heavily calcified mitral annulus. We used a piece of autologous pericardium to cover the raw surface of the brittle and sandy remnant after limited débridement of calcium and to prevent calcific emboli. This patient was followed up and seen again in 2001, at which time I reported the favorable result of 13 years free of embolism.3Kumar A.S. Massive mitral and myocardial calcification: technical maneuvers for successful valve replacement.Int J Cardiol. 2001; 78: 103-104Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar He was last seen in 2009 and was well. Others4Güden M. Kazimoğlu K. Sanisoğlu I. Sağbas E. Yaman R. Akpinar B. The use of autologous pericardium for complicated mitral valve annulus.Asian Cardiovasc Thorac Ann. 2004; 12: 7-10Crossref PubMed Scopus (4) Google Scholar have also reported the successful use of this technique. Although Hussain and colleagues’ technique1Hussain S.T. Idrees J. Brozzi N.A. Blackstone E.H. Pettersson G.B. Use of annulus washer after debridement: a new mitral valve replacement technique for patients with severe mitral annular calcification.J Thorac Cardiovasc Surg. 2013; 145: 1672-1674Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar is indeed novel, it complicates mitral surgery by the need for aortic approach and adds a considerable amount of foreign material. It is indeed surprising that our publications have not been referred to in their article. Use of annulus washer after debridement: A new mitral valve replacement technique for patients with severe mitral annular calcificationThe Journal of Thoracic and Cardiovascular SurgeryVol. 145Issue 6PreviewExtreme calcification of the mitral annulus (MAC) is a formidable challenge during mitral valve surgery, with the risk of serious and potentially fatal complications such as stroke, atrioventricular disruption, ventricular rupture, valve dehiscence, and periprosthetic leakage.1 A variety of surgical techniques have been developed that vary from avoiding or minimizing any decalcification2 to extensive radical removal of the calcium bar followed by reconstruction of the atrioventricular annulus.3-5 We describe our experience with an intermediate approach that involves limited debridement of the calcified annulus, allowing implantation of a good-sized prosthesis using a felt washer, sandwiched between the annulus and prosthesis, as a support. Full-Text PDF