Vascular Health and Risk Management (Dec 2021)
High Mitral Annulus Calcium Score in Pre-Operative Chest Computerized Tomography and Adverse Outcomes in Mitral Valve Surgery
Abstract
Alexandra Kasim,1,* Gabby Elbaz-Greener,2,3,* Amjad Shalabi,4– 6 Erez Kachel,4– 6 Liza Grosman-Rimon,4,5 Michael Jerdev,4 offer amir,2– 5 Shemy Carasso2– 5 1Department of Radiology, B Padeh Medical Center, Poriya, Israel; 2Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel; 3Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; 4Cardiovascular Institute, B Padeh Medical Center, Poriya, Israel; 5The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; 6Department of Cardiac Surgery, B Padeh Medical Center, Poriya, Israel*These authors contributed equally to this workCorrespondence: Gabby Elbaz-GreenerDepartment of Cardiology, Hadassah Medical Center, Room Number 114, Jerusalem, IsraelTel +97226776564Fax +97226411028Email [email protected]: Severe mitral annulus calcification (MAC) is believed to bear high operative and post-operative risk during mitral valve replacement (MVR) surgery, including longer surgery time, post-surgical valvular leaks and increased rate of embolic phenomena. We hypothesized that quantification of mitral calcium in pre-operative chest computerized tomography (CCT), performed to assess aortic root before cross-clamping may help in risk assessment of adverse intraoperative and postoperative outcomes in patients undergoing MVR.Methods: We included patients who underwent MVR between the years 2015 and 2018 at Poriya medical center. Preoperative CCT was performed using Philips iCT 256 and Agatston mitral annulus calcium score (MACS) was retrospectively calculated using Philips Intellispace portal version 8.0. Patients were divided into MACS quintiles; 1– 3 quintiles were grouped (Low MACS) and compared to the 4– 5 quintiles (High MACS) group for demographic, clinical operative and post-operative parameters.Results: A total of 66 patients had MVR, out of which 61% were males, with mean age of 64± 9. Concomitant coronary or valvular procedures were done in 60% of patients. The median MACS was 43. High MACS (≥ 854) was not associated with longer bypass or cross clamp times. No differences in the MVR results were found between the groups. There were 6 post-operative embolic events; 1 mesenteric and 5 cerebral, which were not associated with MACS.Conclusion: MACS did not seem to be related to adverse outcomes in MVR. Due to a low event rate and probable pre-selection of patients without extreme mitral annulus calcifications our results should be confirmed in larger prospective study.Keywords: mitral annulus calcification, MACS, mitral valve replacement, MVR
