Mitral annular calcification (MAC) is a multifactorial chronic disease and a challenging entity to the surgeon. For cases of MAC, we perform the “Pack and Seal technique”, a calcium-respecting approach that allows safe mitral valve replacement (MVR). Nine MVRs were performed where surgery was elective, except for one urgent active endocarditis (mean EuroSCORE II was 5.95±3.71). The mean patient age was 71.9±10.6 years and mean body mass index was 26.4±3.8. No operative and 30-day deaths were reported. No postoperative leakages were found. No reoperations for bleeding were needed. One stroke was reported, with no major sequelae. Two pacemaker implantations were performed because of postoperative atrio-ventricular block. We report the “Pack and Seal” technique as a safe and reproducible surgical approach, with favourable in-hospital results.