Transcatheter Mitral Valve Replacement in Mitral Annular Calcification

Study Questions:

What is the 1-year outcome of transcatheter mitral valve replacement (TMVR) performed in patients with severe mitral annular calcification (MAC) using balloon-expandable aortic transcatheter valves?

Methods:

The authors reported the outcome of 116 extreme surgical risk patients who were enrolled in the TMVR in MAC Global Registry; the analysis included 106 patients with complete 1-year follow-up after TMVR.

Results:

The mean age was 73 years, and the majority (68%) of the patients were female. The mean Society of Thoracic Surgeons score was 15.3 ± 11.6%, and 90% were in New York Heart Association (NYHA) functional class III or IV. Thirty-day mortality was 25% and 1-year all-cause mortality was 53.7%. Of the 77 patients who survived to 30 days, 49 (64%) were alive at 1 year and 72% were in NYHA class I and II. Among 34 patients whose echocardiography data were available at 1 year, left ventricular ejection fraction was 58%, mean mitral valve area was 1.9 ± 0.5 cm2, mean mitral gradient was 5.8 mm Hg, and 75% had zero or trace mitral regurgitation.

Conclusions:

TMVR has a high early mortality for patients with MAC. However, patients who survive to 30 days have a sustained improvement of symptoms and improved survival to 1 year.

Perspective:

Patients with severe MAC and symptomatic mitral valve dysfunction have limited surgical options. While the high early mortality in this study is sobering, patients who survived past 30 days did very well. With further refinement of technique and experience, and with development of dedicated devices, TMVR is likely to emerge as the treatment of choice for these challenging patients.

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound, Mitral Regurgitation

Keywords: Cardiac Surgical Procedures, Echocardiography, Geriatrics, Heart Failure, Heart Valve Diseases, Mitral Valve Insufficiency, Mitral Valve Stenosis, Outcome Assessment (Health Care), Stroke Volume, Transcatheter Aortic Valve Replacement


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