{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:02:54Z","timestamp":1791892974095,"version":"4.3.4"},"reference-count":102,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100005348","name":"American Association for Thoracic Surgery","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005348","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jtcvsonline.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Thoracic and Cardiovascular Surgery"],"published-print":{"date-parts":[[2025,8]]},"DOI":"10.1016\/j.jtcvs.2025.04.003","type":"journal-article","created":{"date-parts":[[2025,5,3]],"date-time":"2025-05-03T09:04:36Z","timestamp":1746263076000},"page":"502-522","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":9,"title":["The American Association for Thoracic Surgery (AATS) 2025 Expert Consensus Document: Surgical management of mitral annular calcification"],"prefix":"10.1016","volume":"170","author":[{"given":"Ahmed","family":"El-Eshmawi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Halas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian T.","family":"Bethea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tirone E.","family":"David","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene A.","family":"Grossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayra","family":"Guerrero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir R.","family":"Kapadia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serguei","family":"Melnitchouk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Mick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Quintana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Romano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert H.L.","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Unai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi K.","family":"Ghanta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Adams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anyanwu","family":"Anelechi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal G.","family":"Bakaeen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Christopher","family":"Malaisrie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"El-Hamamsy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Tseng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"24","key":"10.1016\/j.jtcvs.2025.04.003_bib1","doi-asserted-by":"crossref","first-page":"3048","DOI":"10.1016\/j.jacc.2020.04.049","article-title":"The natural history of severe calcific mitral stenosis","volume":"75","author":"Kato","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib2","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jcmg.2011.02.002","article-title":"Atherosclerosis in ancient Egyptian mummies: the Horus study","volume":"4","author":"Allam","year":"2011","journal-title":"JACC Cardiovasc Imaging"},{"issue":"3","key":"10.1016\/j.jtcvs.2025.04.003_bib3","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/S0022-5223(19)43083-3","article-title":"Causes of early postoperative death following cardiac valve replacement. Clinico-pathologic correlations in 64 patients studied at necropsy","volume":"54","author":"Roberts","year":"1967","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0003-4975(10)63386-3","article-title":"Does preservation of the posterior chordae tendineae enhance survival during mitral valve replacement?","volume":"28","author":"Miller","year":"1979","journal-title":"Ann Thorac Surg"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib5","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/S0022-5223(96)70332-X","article-title":"Extensive calcification of the mitral valve anulus: pathology and surgical management","volume":"111","author":"Carpentier","year":"1996","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"3","key":"10.1016\/j.jtcvs.2025.04.003_bib6","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/S0022-5223(03)00081-3","article-title":"Mitral valve surgery in patients with extensive calcification of the mitral annulus","volume":"126","author":"Feindel","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"7","key":"10.1016\/j.jtcvs.2025.04.003_bib7","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.018514","article-title":"Surgical and transcatheter mitral valve replacement in mitral annular calcification: a systematic review","volume":"10","author":"Alexis","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"18","key":"10.1016\/j.jtcvs.2025.04.003_bib8","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1016\/j.jcin.2023.06.041","article-title":"5-year prospective evaluation of mitral valve-in-valve, valve-in-ring, and valve-in-MAC outcomes: MITRAL trial final results","volume":"16","author":"Guerrero","year":"2023","journal-title":"JACC Cardiovasc Interv"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib9","first-page":"49","article-title":"Early outcomes of transatrial mitral valve replacement in severe mitral annular calcification","volume":"9","author":"Kawano","year":"2021","journal-title":"J Thorac Cardiovasc Surg Tech"},{"issue":"11","key":"10.1016\/j.jtcvs.2025.04.003_bib10","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1161\/01.CIR.0000058168.26163.BC","article-title":"Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study","volume":"107","author":"Fox","year":"2003","journal-title":"Circulation"},{"issue":"3","key":"10.1016\/j.jtcvs.2025.04.003_bib11","doi-asserted-by":"crossref","first-page":"e111","DOI":"10.1093\/ehjci\/jeab185","article-title":"Mitral annular calcification and valvular dysfunction: multimodality imaging evaluation, grading, and management","volume":"23","author":"Xu","year":"2022","journal-title":"Eur Heart J Cardiovasc Imaging"},{"issue":"19","key":"10.1016\/j.jtcvs.2025.04.003_bib12","doi-asserted-by":"crossref","first-page":"2397","DOI":"10.1016\/j.jacc.2017.02.026","article-title":"Relation of mitral valve surgery volume to repair rate, durability, and survival","volume":"69","author":"Chikwe","year":"2017","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"10.1016\/j.jtcvs.2025.04.003_bib13","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/j.athoracsur.2019.04.080","article-title":"Characterizing risks associated with mitral annular calcification in mitral valve replacement","volume":"108","author":"Kaneko","year":"2019","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib14","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/0003-4975(91)91420-Z","article-title":"Mitral valve repair in the extensively calcified mitral valve annulus","volume":"52","author":"el Asmar","year":"1991","journal-title":"Ann Thorac Surg"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib15","series-title":"Carpentier's Reconstructive Valve Surgery","author":"Carpentier","year":"2010"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib16","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0003-4975(00)01347-3","article-title":"Valve repair in mitral regurgitation complicated by severe annulus calcification","volume":"70","author":"Ng","year":"2000","journal-title":"Ann Thorac Surg"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib17","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/j.ejcts.2007.06.044","article-title":"Mitral annulus calcification: determinants of repair feasibility, early and late surgical outcome","volume":"32","author":"d'Alessandro","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"issue":"7","key":"10.1016\/j.jtcvs.2025.04.003_bib18","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1055\/s-2006-924438","article-title":"Decalcification of the mitral annulus: surgical experience in 81 patients","volume":"54","author":"Dietrich","year":"2006","journal-title":"Thorac Cardiovasc Surg"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib19","first-page":"1","article-title":"Contemporary surgical techniques for mitral valve replacement in extensive mitral annular calcification","volume":"22","author":"El-Eshmawi","year":"2023","journal-title":"J Thorac Cardiovasc Surg Tech"},{"issue":"3","key":"10.1016\/j.jtcvs.2025.04.003_bib20","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/0003-4975(94)90728-5","article-title":"Severe calcification does not affect long-term outcome of mitral valve repair","volume":"58","author":"Grossi","year":"1994","journal-title":"Ann Thorac Surg"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib21","first-page":"81","article-title":"Short-term outcomes of robotic left ventricular patch ventriculoplasty for significant mitral annular calcification","volume":"27","author":"Naito","year":"2024","journal-title":"J Thorac Cardiovasc Surg Tech"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib22","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/j.athoracsur.2008.12.041","article-title":"Midterm survival after decalcification of the mitral annulus","volume":"87","author":"Papadopoulos","year":"2009","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"10.1016\/j.jtcvs.2025.04.003_bib23","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.athoracsur.2018.07.098","article-title":"Does mitral valve calcium in patients undergoing mitral valve replacement portend worse survival?","volume":"107","author":"Saran","year":"2019","journal-title":"Ann Thorac Surg"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib24","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/j.athoracsur.2018.08.017","article-title":"Outcomes of valve repair for degenerative disease in patients with mitral annular calcification","volume":"107","author":"Tomsic","year":"2019","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"10.1016\/j.jtcvs.2025.04.003_bib25","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.athoracsur.2015.08.071","article-title":"Mitral valve surgery in patients with severe mitral annular calcification","volume":"101","author":"Uchimuro","year":"2016","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"10.1016\/j.jtcvs.2025.04.003_bib26","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/HCO.0000000000000718","article-title":"Surgical management of mitral annular calcification","volume":"35","author":"El-Eshmawi","year":"2020","journal-title":"Curr Opin Cardiol"},{"issue":"6","key":"10.1016\/j.jtcvs.2025.04.003_bib27","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1016\/S0022-5223(03)01291-1","article-title":"Midterm results of edge-to-edge mitral valve repair without annuloplasty","volume":"126","author":"Maisano","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"5","key":"10.1016\/j.jtcvs.2025.04.003_bib28","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1016\/j.athoracsur.2008.09.014","article-title":"Building a new annulus: a technique for mitral valve replacement in heavily calcified annulus","volume":"87","author":"Di Stefano","year":"2009","journal-title":"Ann Thorac Surg"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib29","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/S0003-4975(10)63305-X","article-title":"Mitral valve replacement: a nine-year follow-up of risks and survivals","volume":"27","author":"Chaffin","year":"1979","journal-title":"Ann Thorac Surg"},{"issue":"9 suppl","key":"10.1016\/j.jtcvs.2025.04.003_bib30","doi-asserted-by":"crossref","first-page":"II137","DOI":"10.1161\/01.CIR.92.9.137","article-title":"Long-term outcome of cardiac surgery in patients with mitral stenosis and severe pulmonary hypertension","volume":"92","author":"Vincens","year":"1995","journal-title":"Circulation"},{"issue":"8","key":"10.1016\/j.jtcvs.2025.04.003_bib31","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/0002-9149(72)90005-7","article-title":"Regression of extreme pulmonary hypertension after mitral valve surgery","volume":"30","author":"Zener","year":"1972","journal-title":"Am J Cardiol"},{"issue":"5","key":"10.1016\/j.jtcvs.2025.04.003_bib33","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/j.jtcvs.2015.12.063","article-title":"A contemporary analysis of pulmonary hypertension in patients undergoing mitral valve surgery: is this a risk factor?","volume":"151","author":"Enter","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"2","key":"10.1016\/j.jtcvs.2025.04.003_bib34","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.jtcvs.2016.02.038","article-title":"The impact of concomitant pulmonary hypertension on early and late outcomes following surgery for mitral stenosis","volume":"152","author":"Yang","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib35","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/j.1540-8191.1997.tb00133.x","article-title":"Ultrasonic debridement of mitral calcification","volume":"12","author":"Baumgartner","year":"1997","journal-title":"J Card Surg"},{"issue":"2","key":"10.1016\/j.jtcvs.2025.04.003_bib36","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/j.1540-8191.1993.tb00361.x","article-title":"Mitral valve replacement in the presence of severe valvular and annular calcification","volume":"8","author":"McEnany","year":"1993","journal-title":"J Card Surg"},{"issue":"6","key":"10.1016\/j.jtcvs.2025.04.003_bib37","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1111\/j.1540-8191.2007.00463.x","article-title":"Mitral valve replacement for a severely calcified mitral annulus","volume":"22","author":"Yoshikai","year":"2007","journal-title":"J Card Surg"},{"issue":"6","key":"10.1016\/j.jtcvs.2025.04.003_bib38","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1016\/j.athoracsur.2021.11.066","article-title":"Ultrasonic emulsification of severe mitral annular calcification during mitral valve replacement","volume":"113","author":"Brescia","year":"2022","journal-title":"Ann Thorac Surg"},{"issue":"5821","key":"10.1016\/j.jtcvs.2025.04.003_bib39","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1136\/bmj.3.5821.274","article-title":"Ultrasonic decalcification of calcified cardiac valves and annuli","volume":"3","author":"Brown","year":"1972","journal-title":"Br Med J"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib40","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.atssr.2022.08.002","article-title":"Complete excision of mitral annular calcification can be achieved with a low mortality risk","volume":"1","author":"Shi","year":"2023","journal-title":"Ann Thorac Surg Short Rep"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib41","article-title":"Cavitron ultrasonic surgical aspirator for mitral annular decalcification","volume":"2021","author":"Weininger","year":"2021","journal-title":"Multimed Man Cardiothorac Surg"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib42","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1161\/01.CIR.81.4.1173","article-title":"Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease","volume":"81","author":"Crawford","year":"1990","journal-title":"Circulation"},{"issue":"3 Pt 2","key":"10.1016\/j.jtcvs.2025.04.003_bib43","first-page":"II76","article-title":"The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation","volume":"68","author":"David","year":"1983","journal-title":"Circulation"},{"issue":"3","key":"10.1016\/j.jtcvs.2025.04.003_bib44","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/S0735-1097(87)80199-7","article-title":"Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function: an intraoperative two-dimensional echocardiographic study","volume":"10","author":"Goldman","year":"1987","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"10.1016\/j.jtcvs.2025.04.003_bib45","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1161\/01.CIR.73.6.1310","article-title":"Valvular-ventricular interaction: importance of the mitral apparatus in canine left ventricular systolic performance","volume":"73","author":"Hansen","year":"1986","journal-title":"Circulation"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib46","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0022-5223(19)36473-6","article-title":"Relative contributions of the anterior and posterior mitral chordae tendineae to canine global left ventricular systolic function","volume":"93","author":"Hansen","year":"1987","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"5 suppl","key":"10.1016\/j.jtcvs.2025.04.003_bib47","first-page":"IV89","article-title":"Importance of the mitral subvalvular apparatus for left ventricular segmental systolic mechanics","volume":"82","author":"Yun","year":"1990","journal-title":"Circulation"},{"issue":"6","key":"10.1016\/j.jtcvs.2025.04.003_bib48","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1016\/j.athoracsur.2004.10.029","article-title":"Mitral valve replacement with and without chordal preservation in a rheumatic population: serial echocardiographic assessment of left ventricular size and function","volume":"79","author":"Chowdhury","year":"2005","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"10.1016\/j.jtcvs.2025.04.003_bib49","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1093\/icvts\/ivs379","article-title":"Preservation versus non-preservation of mitral valve apparatus during mitral valve replacement: a meta-analysis of 3835 patients","volume":"15","author":"de Oliveira S\u00e1","year":"2012","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib50","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S0003-4975(99)00337-9","article-title":"Use of the anterior mitral leaflet to reinforce the posterior mitral annulus after debridement of calcium","volume":"68","author":"Casselman","year":"1999","journal-title":"Ann Thorac Surg"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib51","first-page":"100","article-title":"Complete excision of mitral annular calcification and double valve replacement with aortomitral curtain reconstruction","volume":"27","author":"Connolly","year":"2024","journal-title":"J Thorac Cardiovasc Surg Tech"},{"issue":"5","key":"10.1016\/j.jtcvs.2025.04.003_bib52","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/S0022-5223(97)70080-1","article-title":"Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body","volume":"114","author":"David","year":"1997","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"5","key":"10.1016\/j.jtcvs.2025.04.003_bib53","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1016\/j.jtcvs.2021.09.011","article-title":"Outcomes of combined aortic and mitral valve replacement with reconstruction of the fibrous skeleton of the heart","volume":"164","author":"David","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"7","key":"10.1016\/j.jtcvs.2025.04.003_bib54","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.jacc.2019.07.006","article-title":"Prevention, diagnosis, and management of radiation-associated cardiac disease: JACC scientific expert panel","volume":"74","author":"Desai","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib55","first-page":"13","article-title":"Surgical treatment of prosthetic valve endocarditis","volume":"7","author":"Lytle","year":"1995","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib56","article-title":"Reconstruction of fibrous skeleton: technique, pitfalls and results","volume":"2014","author":"Pettersson","year":"2014","journal-title":"Multimed Man Cardiothorac Surg"},{"issue":"2","key":"10.1016\/j.jtcvs.2025.04.003_bib57","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.amjcard.2010.09.014","article-title":"Different clinical outcome of paravalvular leakage after aortic or mitral valve replacement","volume":"107","author":"Cho","year":"2011","journal-title":"Am J Cardiol"},{"issue":"11","key":"10.1016\/j.jtcvs.2025.04.003_bib58","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s11748-013-0207-7","article-title":"Surgical management of mitral annular calcification","volume":"61","author":"Okada","year":"2013","journal-title":"Gen Thorac Cardiovasc Surg"},{"issue":"3","key":"10.1016\/j.jtcvs.2025.04.003_bib59","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.jtcvs.2018.09.003","article-title":"Open atrial transcatheter mitral valve replacement in patients with mitral annular calcification","volume":"157","author":"Russell","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"7","key":"10.1016\/j.jtcvs.2025.04.003_bib60","doi-asserted-by":"crossref","first-page":"2410","DOI":"10.1111\/jocs.15535","article-title":"Anatomic classification of mitral annular calcification for surgical and transcatheter mitral valve replacement","volume":"36","author":"Alexis","year":"2021","journal-title":"J Card Surg"},{"issue":"9","key":"10.1016\/j.jtcvs.2025.04.003_bib61","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1016\/j.jcmg.2020.03.013","article-title":"A cardiac computed tomography-based score to categorize mitral annular calcification severity and predict valve embolization","volume":"13","author":"Guerrero","year":"2020","journal-title":"JACC Cardiovasc Imaging"},{"issue":"18","key":"10.1016\/j.jtcvs.2025.04.003_bib62","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1016\/j.jcin.2023.06.044","article-title":"Diagnosis, classification, and management strategies for mitral annular calcification: a heart valve collaboratory position statement","volume":"16","author":"Guerrero","year":"2023","journal-title":"JACC Cardiovasc Interv"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib63","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.athoracsur.2024.09.036","article-title":"Direct implantation of transcatheter valve in mitral annular calcification: a multicenter study","volume":"119","author":"Fatehi Hassanabad","year":"2025","journal-title":"Ann Thorac Surg"},{"issue":"13","key":"10.1016\/j.jtcvs.2025.04.003_bib64","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1016\/j.jacc.2018.07.033","article-title":"Open atrial transcatheter mitral valve replacement in patients with mitral annular calcification","volume":"72","author":"Russell","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"10.1016\/j.jtcvs.2025.04.003_bib65","doi-asserted-by":"crossref","first-page":"e101","DOI":"10.1016\/j.jtcvs.2016.06.061","article-title":"Open vascular plug placement to complete mitral valve seating in radiation heart disease","volume":"152","author":"Vekstein","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"20","key":"10.1016\/j.jtcvs.2025.04.003_bib66","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1016\/j.jcin.2021.08.044","article-title":"The art of SAPIEN 3 transcatheter mitral valve replacement in valve-in-ring and valve-in-mitral-annular-calcification procedures","volume":"14","author":"Babaliaros","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"issue":"18","key":"10.1016\/j.jtcvs.2025.04.003_bib67","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1016\/j.jcin.2024.05.041","article-title":"5-year outcomes of anterior mitral leaflet laceration to prevent outflow obstruction","volume":"17","author":"Khan","year":"2024","journal-title":"JACC Cardiovasc Interv"},{"issue":"18","key":"10.1016\/j.jtcvs.2025.04.003_bib68","article-title":"Novel leaflet modification of the native anterior mitral valve leaflet for transcatheter mitral valve replacement","volume":"29","author":"Parikh","year":"2024","journal-title":"JACC Case Rep"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib71","unstructured":"Medtronic Cardiovascular. Transcatheter mitral valve replacement with the Medtronic Intrepid\u2122 TMVR system in patients with severe symptomatic mitral regurgitation (APOLLO). Accessed January 3, 2025. https:\/\/clinicaltrials.gov\/study\/NCT03242642?tab=history&a=23"},{"issue":"18","key":"10.1016\/j.jtcvs.2025.04.003_bib72","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1016\/j.jcin.2024.07.038","article-title":"Outcomes following transcatheter mitral valve replacement using dedicated devices in patients with mitral annular calcification","volume":"17","author":"Coisne","year":"2024","journal-title":"JACC Cardiovasc Interv"},{"issue":"19","key":"10.1016\/j.jtcvs.2025.04.003_bib73","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.123.031118","article-title":"Feasibility and outcomes of mitral transcatheter edge-to-edge repair in patients with variable degrees of mitral annular calcification","volume":"12","author":"Hatab","year":"2023","journal-title":"J Am Heart Assoc"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib74","first-page":"618","article-title":"Contemporary experience of mitral transcatheter edge-to-edge repair technology in patients with mitral annular calcification","volume":"103","author":"Mustafa","year":"2024","journal-title":"Catheter Cardiovasc Interv"},{"issue":"11","key":"10.1016\/j.jtcvs.2025.04.003_bib75","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1016\/j.jcmg.2016.09.001","article-title":"Severe mitral annular calcification: multimodality imaging for therapeutic strategies and interventions","volume":"9","author":"Eleid","year":"2016","journal-title":"JACC Cardiovasc Imaging"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib76","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jcmg.2019.10.027","article-title":"Imaging guidance for transcatheter mitral valve intervention on prosthetic valves, rings, and annular calcification","volume":"14","author":"Little","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib77","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1053\/j.semtcvs.2020.05.021","article-title":"Severe mitral annular calcification and mitral valve surgery: an algorithmic approach to management","volume":"32","author":"Pizano","year":"2020","journal-title":"Semin Thorac Cardiovasc Surg"},{"issue":"2","key":"10.1016\/j.jtcvs.2025.04.003_bib78","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.jtcvs.2018.05.099","article-title":"Current and evolving strategies in the management of severe mitral annular calcification","volume":"157","author":"Bedeir","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib79","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.ejcts.2008.06.009","article-title":"Risk factors for posterior ventricular rupture after mitral valve replacement: results of 2560 patients","volume":"34","author":"Deniz","year":"2008","journal-title":"Eur J Cardiothorac Surg"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib80","first-page":"213","article-title":"Novel adjunctive use of venoarterial extracorporeal membrane oxygenation in atrioventricular groove disruption following mitral valve surgery","volume":"3","author":"Salna","year":"2020","journal-title":"J Thorac Cardiovasc Surg Tech"},{"issue":"3","key":"10.1016\/j.jtcvs.2025.04.003_bib81","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/j.athoracsur.2020.05.160","article-title":"Left circumflex artery injury after mitral valve surgery: an algorithm management proposal","volume":"111","author":"Bargagna","year":"2021","journal-title":"Ann Thorac Surg"},{"issue":"12","key":"10.1016\/j.jtcvs.2025.04.003_bib82","doi-asserted-by":"crossref","first-page":"4088","DOI":"10.1111\/jocs.17055","article-title":"Acute iatrogenic complications after mitral valve repair","volume":"37","author":"Paparella","year":"2022","journal-title":"J Card Surg"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib83","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2023.1183182","article-title":"When too much closeness harms: circumflex artery injury during mitral valve surgery","volume":"10","author":"Dumps","year":"2023","journal-title":"Front Cardiovasc Med"},{"issue":"12","key":"10.1016\/j.jtcvs.2025.04.003_bib84","article-title":"Left circumflex artery injury following surgical mitral valve replacement: a case report","volume":"5","author":"Gaba","year":"2021","journal-title":"Eur Heart J Case Rep"},{"issue":"17","key":"10.1016\/j.jtcvs.2025.04.003_bib85","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1016\/j.jacc.2018.02.054","article-title":"1-year outcomes of transcatheter mitral valve replacement in patients with severe mitral annular calcification","volume":"71","author":"Guerrero","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"14","key":"10.1016\/j.jtcvs.2025.04.003_bib86","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/j.jacc.2024.02.007","article-title":"Transcatheter myotomy to reduce left ventricular outflow obstruction","volume":"83","author":"Greenbaum","year":"2024","journal-title":"J Am Coll Cardiol"},{"issue":"10","key":"10.1016\/j.jtcvs.2025.04.003_bib87","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.121.010854","article-title":"Predictors of left ventricular outflow tract obstruction after transcatheter mitral valve replacement in severe mitral annular calcification: an analysis of the Transcatheter Mitral Valve Replacement in Mitral Annular Calcification Global Registry","volume":"14","author":"El Sabbagh","year":"2021","journal-title":"Circ Cardiovasc Interv"},{"issue":"7","key":"10.1016\/j.jtcvs.2025.04.003_bib88","first-page":"1220","article-title":"Short-term results of alcohol septal ablation as a bail-out strategy to treat severe left ventricular outflow tract obstruction after transcatheter mitral valve replacement in patients with severe mitral annular calcification","volume":"90","author":"Guerrero","year":"2017","journal-title":"Catheter Cardiovasc Interv"},{"issue":"16","key":"10.1016\/j.jtcvs.2025.04.003_bib89","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1016\/j.jacc.2017.02.038","article-title":"Clinical trial principles and endpoint definitions for paravalvular leaks in surgical prosthesis: an expert statement","volume":"69","author":"Ruiz","year":"2017","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"10.1016\/j.jtcvs.2025.04.003_bib90","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1093\/eurheartj\/ehs347","article-title":"Review of surgical prosthetic paravalvular leaks: diagnosis and catheter-based closure","volume":"34","author":"Kliger","year":"2013","journal-title":"Eur Heart J"},{"issue":"5","key":"10.1016\/j.jtcvs.2025.04.003_bib91","first-page":"e72","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"issue":"17","key":"10.1016\/j.jtcvs.2025.04.003_bib92","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1016\/j.jacc.2015.08.872","article-title":"Mitral annulus calcification","volume":"66","author":"Abramowitz","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.jtcvs.2025.04.003_bib93","series-title":"Cardiac Surgery in the Adult","first-page":"761","article-title":"Pathophysiology of mitral valve disease","author":"Fann","year":"2017"},{"issue":"1","key":"10.1016\/j.jtcvs.2025.04.003_bib94","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jtcvs.2024.07.048","volume":"169","author":"Milojevic","year":"2025","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"2","key":"10.1016\/j.jtcvs.2025.04.003_bib95","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.atherosclerosis.2010.08.072","article-title":"Relationships of mitral annular calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA)","volume":"213","author":"Kanjanauthai","year":"2010","journal-title":"Atherosclerosis"},{"issue":"4","key":"10.1016\/j.jtcvs.2025.04.003_bib96","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.jtcvs.2017.01.003","article-title":"The American Association for Thoracic Surgery\/Society of Thoracic Surgeons position statement on developing clinical practice documents","volume":"153","author":"Bakaeen","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"2","key":"10.1016\/j.jtcvs.2025.04.003_bib97","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.118.008513","article-title":"Disease activity in mitral annular calcification","volume":"12","author":"Massera","year":"2019","journal-title":"Circ Cardiovasc Imaging"},{"issue":"5","key":"10.1016\/j.jtcvs.2025.04.003_bib98","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/j.ahj.2013.08.015","article-title":"Risk factors associated with the incidence and progression of mitral annulus calcification: the multi-ethnic study of atherosclerosis","volume":"166","author":"Elmariah","year":"2013","journal-title":"Am Heart J"},{"issue":"12","key":"10.1016\/j.jtcvs.2025.04.003_bib99","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.1111\/j.1538-7836.2009.03630.x","article-title":"Warfarin use and the risk of valvular calcification","volume":"7","author":"Lerner","year":"2009","journal-title":"J Thromb Haemost"},{"issue":"2","key":"10.1016\/j.jtcvs.2025.04.003_bib100","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.atherosclerosis.2003.12.018","article-title":"Mitral annular calcification is a predictor for incident atrial fibrillation","volume":"173","author":"Fox","year":"2004","journal-title":"Atherosclerosis"},{"issue":"Suppl E","key":"10.1016\/j.jtcvs.2025.04.003_bib101","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1093\/eurheartj\/9.suppl_E.77","article-title":"Mitral calcification in aortic stenosis","volume":"9","author":"Michel","year":"1988","journal-title":"Eur Heart J"},{"issue":"10","key":"10.1016\/j.jtcvs.2025.04.003_bib102","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1016\/0002-9149(83)90202-3","article-title":"Conduction disturbances related to the site and severity of mitral annular calcification: a 2-dimensional echocardiographic and electrocardiographic correlative study","volume":"51","author":"Takamoto","year":"1983","journal-title":"Am J Cardiol"},{"issue":"6","key":"10.1016\/j.jtcvs.2025.04.003_bib103","first-page":"611","article-title":"Surgery for infective endocarditis on mitral annulus calcification","volume":"16","author":"Vistarini","year":"2007","journal-title":"J Heart Valve Dis"},{"issue":"12","key":"10.1016\/j.jtcvs.2025.04.003_bib104","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1016\/S0002-9149(97)00233-6","article-title":"Possible association of thrombotic, nonbacterial vegetations of the mitral ring\u2014mitral annular calcium and stroke","volume":"79","author":"Eicher","year":"1997","journal-title":"Am J Cardiol"},{"issue":"7","key":"10.1016\/j.jtcvs.2025.04.003_bib107","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.jacc.2022.06.009","article-title":"Management of patients with severe mitral annular calcification: JACC State-of-the-Art review","volume":"80","author":"Chehab","year":"2022","journal-title":"J Am Coll Cardiol"}],"container-title":["The Journal of Thoracic and Cardiovascular Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022522325002922?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022522325002922?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T21:02:18Z","timestamp":1783026138000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0022522325002922"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":102,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["S0022522325002922"],"URL":"https:\/\/doi.org\/10.1016\/j.jtcvs.2025.04.003","relation":{},"ISSN":["0022-5223"],"issn-type":[{"value":"0022-5223","type":"print"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The American Association for Thoracic Surgery (AATS) 2025 Expert Consensus Document: Surgical management of mitral annular calcification","name":"articletitle","label":"Article Title"},{"value":"The Journal of Thoracic and Cardiovascular Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jtcvs.2025.04.003","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 by The American Association for Thoracic Surgery","name":"copyright","label":"Copyright"}]}}