Early and Intermediate Outcomes of Cavitron Ultrasonic Surgical Aspiration to Treat Mitral Annular Calcification

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 from March 2021 through December 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 (interquartile range [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.