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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Long-term clinical and echocardiographic outcomes after mitral valve surgery for severe mitral annular calcification

  • Yoganiranjana Dharuman1
  • Egan Kalmykov2
  • Mirko Doss3
  1. 1Medical Faculty, RWTH Aachen University
  2. 2Department of Endovascular Surgery, University Clinic of Brandenburg/Havel
  3. 3Department of Cardiothoracic Surgery, Helios Hospital Siegburg
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Abstract

Objective: To assess the long-term clinical and echocardiographic outcomes of mitral valve surgery with annular decalcification and pericardial patch reconstruction in patients with severe mitral annular calcification (MAC).

Patients and methods: Between 2012 and 2022, 112 consecutive high-risk patients (67 women, 45 men; mean age 66.5 ± 13.6 years) underwent surgery for severe MAC with mitral stenosis and/or regurgitation. Mitral valve repair was performed in 55 patients (49%) and replacement in 57 (51%). Concomitant procedures were performed in 65 patients (58%). Mean follow-up was 97 ± 48 months.

Results: Early mortality was 6.3% ( n = 7) and late mortality was 23.2% ( n = 26). Survival was 89.3%, 77.2%, and 64.1% at 60, 96, and 144 months, respectively. Freedom from reoperation was 98.3% at 60 months and 93.3% at 96 months. At follow-up, no surviving patient had more than grade III mitral regurgitation. Grade III regurgitation was present in 3 patients (4%), while no patient had grade IV regurgitation. Left atrial diameter, left ventricular end-diastolic diameter, and mean transvalvular gradient were significantly lower than before surgery.

Conclusion: In this high-risk cohort, annular decalcification and pericardial patch reconstruction provided durable valve function and acceptable long-term survival in patients who survived the perioperative period. Perioperative mortality, however, remained substantial.

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Cite

BibTeXRIS
BibTeX
@article{dharuman2026longterm,
  title = {{Long-term clinical and echocardiographic outcomes after mitral valve surgery for severe mitral annular calcification}},
  author = {Yoganiranjana Dharuman and Egan Kalmykov and Mirko Doss},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1881651},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1881651/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Long-term clinical and echocardiographic outcomes after mitral valve surgery for severe mitral annular calcification
AU  - Yoganiranjana Dharuman
AU  - Egan Kalmykov
AU  - Mirko Doss
PY  - 2026
DA  - 2026/10/28
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1881651
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1881651/full
AB  - Objective: To assess the long-term clinical and echocardiographic outcomes of mitral valve surgery with annular decalcification and pericardial patch reconstruction in patients with severe mitral annular calcification (MAC).  Patients and methods: Between 2012 and 2022, 112 consecutive high-risk patients (67 women, 45 men; mean age 66.5 ± 13.6 years) underwent surgery for severe MAC with mitral stenosis and/or regurgitation. Mitral valve repair was performed in 55 patients (49%) and replacement in 57 (51%). Concomitant procedures were performed in 65 patients (58%). Mean follow-up was 97 ± 48 months.  Results: Early mortality was 6.3% ( n = 7) and late mortality was 23.2% ( n = 26). Survival was 89.3%, 77.2%, and 64.1% at 60, 96, and 144 months, respectively. Freedom from reoperation was 98.3% at 60 months and 93.3% at 96 months. At follow-up, no surviving patient had more than grade III mitral regurgitation. Grade III regurgitation was present in 3 patients (4%), while no patient had grade IV regurgitation. Left atrial diameter, left ventricular end-diastolic diameter, and mean transvalvular gradient were significantly lower than before surgery.  Conclusion: In this high-risk cohort, annular decalcification and pericardial patch reconstruction provided durable valve function and acceptable long-term survival in patients who survived the perioperative period. Perioperative mortality, however, remained substantial.
SN  - 2297-055X
ER  -