For mitral valve disease with mitral annular calcification (MAC), surgery remains challenging. Up to now, there is no ideal management strategy or patient selection standard, and perioperative and periprocedural morbidity and mortality rates remain high. The recent surge of patients presenting with MAC has been accompanied by increased interest in MAC surgery and interventions. The American Association for Thoracic Surgery Clinical Practice Standards Committee is meant to provide a simplified outline for managing MAC. Combined with progress of MAC therapy, a detailed interpretation of the 2025 expert consensus is provided which include patient selection, preoperative evaluation (especially imaging evaluation), indications of intervention, surgical and transcatheter therapeutic options, and postoperative complications and remedial measures.
