Does Mitral Valve Calcium in Patients Undergoing Mitral Valve Replacement Portend Worse Survival?

Saran and colleagues sought to evaluate the prevalence of mitral annual calcification (MAC) in patients undergoing valve replacement and to characterize the effect of MAC on postsurgical outcomes. They also discuss their conservative operative approach.

The authors retrospectively analyzed medical records for 496 patients who underwent isolated primary mitral valve replacement at their institution between 2000 and 2015. MAC was present in 115 patients (23%). Although patients with MAC had worse survival than patients without (unadjusted hazard ratio, 1.62; 95% confidence interval 1.20 to 2.18; p = 0.002), the authors conclude that this was due to the prevalence of comorbidities in this group. Multivariable analysis identified risk factors for mortality that included older age, diabetes, dialysis, previous aortic valve surgery, and bioprosthetic valve placement, but not MAC. The incidence of stroke was higher in patients with any mitral calcification, underscoring the importance of thoroughly clearing calcium debris from the surgical field.