Early and intermediate outcomes of cavitron ultrasonic surgical aspiration to treat mitral annular calcification

Abstract OBJECTIVES Severe mitral annular calcification (MAC) carries an increased risk of perioperative complications in patients undergoing mitral valve surgery and may be considered a prohibitive surgical risk. Cavitron ultrasonic surgical aspiration (CUSA) has been reported as a method for controlled debridement of severe MAC during mitral valve surgery, however experience in the literature is limited. METHODS We assessed 30-day and intermediate-term outcomes in 67 consecutive patients (mean age: 72 (SD 9) years; female sex: 65.7% (44/67)) with severe MAC who underwent mitral valve repair or replacement for mitral stenosis and/or regurgitation using CUSA between 3/2021 and 12/2024. Operations included isolated mitral valve replacement (41.8% (28/67)), isolated mitral valve repair (4.5% (3/67)), mitral and aortic valve replacement (37.3% (25/67), mitral valve replacement with coronary bypass (6.0% (4/67)), and mitral and aortic valve replacement with coronary bypass (10.4% (7/67)). Intermediate survival was estimated using the Kaplan–Meier method. RESULTS Mortality rate was 6.0% (4/67), stroke was 3.0% (2/67), and new postoperative atrial fibrillation was 29.0% (20/67). There were no atrioventricular groove ruptures. At a median echocardiographic follow-up time of 361 days (IQR 112, 671) moderate paravalvular leak occurred in 3.0% (1/67). Mid-term all-cause mortality was 9.0% at a mean follow-up time of 42.5 (95% CI 39.0, 46.0) months. CONCLUSIONS The use of CUSA to debride severe mitral annular calcification in patients undergoing mitral valve surgery is associated with acceptable short-term morbidity and mortality and durable intermediate-term results. This technique allows surgical intervention in patients who may otherwise be deemed prohibitive surgical risk.