Focus on Mitral Valve Interventions
Contemporary Transcatheter Mitral Valve Replacement for Mitral Annular Calcification or Ring

https://doi.org/10.1016/j.jcin.2020.07.007Get rights and content
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Abstract

Objectives

The aim of this study was to evaluate outcomes of commercial transcatheter mitral valve replacement (TMVR) for annular rings and calcification using contemporary techniques.

Background

TMVR is evolving in the absence of other viable treatment options for severe mitral annular calcification and failing ring repairs. The concomitant use of laceration of the anterior mitral valve leaflet to prevent left ventricular outflow tract obstruction and pre-emptive alcohol septal ablation is not well studied in clinical practice.

Methods

A single-center study was conducted of valve–in–mitral annular calcification (ViMAC) and valve-in-ring (ViRing) TMVR from September 2015 to April 2020. In-hospital and 30-day outcomes were assessed.

Results

Forty patients underwent TMVR (28 ViMAC and 12 ViRing). Sixteen ViMAC (57%) and 5 ViRing (42%) patients underwent attempted laceration of the anterior mitral valve leaflet to prevent left ventricular outflow tract obstruction. Three patients underwent pre-emptive alcohol septal ablation. The median index hospitalization was 7 days. Six patients died within 30 days of the procedure, 6 (21%) in the ViMAC group and none in the ViRing group. Five patients (13%) had left ventricular outflow tract obstruction: 4 (14%) in the ViMAC cohort and 1 (8%) in the ViRing cohort. Five patients (13%) had either intraprocedural valve embolization or late migration (4 ViMAC and 1 ViRing). Technical success defined according to Mitral Valve Academic Research Consortium criteria was present in 25 patients (63%): 9 (75%) in the ViRing cohort and 16 (57%) in the ViMAC cohort. At 30 days, the mitral valve gradient was significantly reduced (5.5 ± 2.1 vs. 10.6 ± 4.8; p < 0.01). Three patients (8%) had at least moderate residual mitral regurgitation.

Conclusions

Transcatheter ViMAC and ViRing can be successfully performed but frequently require the use of contemporary adjunctive techniques.

Key Words

alcohol septal ablation
LAMPOON
mitral valve replacement
TMVR
transcatheter mitral valve replacement

Abbreviations and Acronyms

ASA
alcohol septal ablation
IQR
interquartile range
LAMPOON
laceration of the anterior mitral valve leaflet to prevent left ventricular outflow tract obstruction
LVOT
left ventricular outflow tract
LVOTO
left ventricular outflow tract obstruction
MAC
mitral annular calcification
MR
mitral regurgitation
MV
mitral valve
TMVR
transcatheter mitral valve replacement
ViMAC
valve–in–mitral annular calcification
ViRing
valve-in-ring

Cited by (0)

Dr. McCabe is the recipient of a Craig Tall and Penny LeGate Term Professorship (used for publication fees and research assistant time to support this manuscript); and has consulted for Boston Scientific, Cardiovascular Systems, Edwards Lifesciences, and Teleflex. Dr. Dvir has consulted for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.