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Review
. 2023 Sep 25;16(18):2195-2210.
doi: 10.1016/j.jcin.2023.06.044.

Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory Position Statement

Mayra E Guerrero  1 , Paul Grayburn  2 , Robert L Smith 2nd  2 , Paul Sorajja  3 , Dee Dee Wang  4 , Yousif Ahmad  5 , David Blusztein  6 , João Cavalcante  3 , Gilbert H L Tang  7 , Gorav Ailawadi  8 , D Scott Lim  9 , Philipp Blanke  10 , Mackram F Eleid  11 , Tsuyoshi Kaneko  12 , Vinod H Thourani  13 , Vinayak Bapat  3 , Michael J Mack  2 , Martin B Leon  6 , Isaac George  6
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Free article
Review

Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory Position Statement

Mayra E Guerrero et al. JACC Cardiovasc Interv. .
Free article

Abstract

Mitral annular calcium (MAC) with severe mitral valvular dysfunction presents a complex problem, as valve replacement, either surgical or transcatheter, is challenging because of anatomy, technical considerations, concomitant comorbidities, and advanced age. The authors review the clinical and anatomical features of MAC that are favorable (green light), challenging (yellow light), or prohibitive (red light) for surgical or transcatheter mitral valve interventions. Under the auspices of the Heart Valve Collaboratory, an expert working group of cardiac surgeons, interventional cardiologists, and interventional imaging cardiologists was formed to develop recommendations regarding treatment options for patients with MAC as well as a proposed grading and staging system using both anatomical and clinical features.

Keywords: mitral annulus calcification; mitral annulus calcification severity classification; mitral valve surgery; transcatheter mitral valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Wang is a consultant for Abbott, Edwards Lifesciences, Boston Scientific, and NeoChord; and has received research grant support from Boston Scientific assigned to Henry Ford Health. Dr Cavalcante has received consulting fees from Abbott Structural, Anteris, AriaCV, Boston Scientific, Edwards Lifesciences, Medtronic, VDyne, W.L. Gore, and XyloCor; and has received research grant support from Abbott Northwestern Hospital Foundation. Dr Tang is a physician proctor and consultant for Medtronic; is a consultant and advisory board member for Abbott Structural Heart; is a consultant for NeoChord; is a physician advisory board member for Boston Scientific and JenaValve; and has received speaker honoraria from Siemens Healthineers. Dr Ailawadi is a consultant for Edwards Lifesciences, Medtronic, Abbott, W.L. Gore, Anteris, Johnson & Johnson, Philips, Artivion, and AtriCure; and holds equity in Anteris, Triflo, and xDot. Dr Lim has received institutional research grant support from Abbott, Boston Scientific, Corvia, Edwards Lifesciences, Medtronic, Trisol, and V-Wave; has received consulting fees from Philips, Valgen, and Venus. Dr George has received consulting honoraria from Zimmer Biomet, AtriCure, Neptune Medical, Abbvie, Johnson & Johnson, and Boston Scientific; has served on advisory boards for Edwards Surgical, Medtronic Surgical, Trisol Medical, Abbvie, Johnson & Johnson, Foldax Medical, Zimmer Biomet, Abbvie, and Boston Scientific; holds equity in Valcare Medical, Durvena, CardioMech, VDyne, MitreMedical, and MITRx; and has received institutional funding to Columbia University from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, and JenaValve. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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