Elsevier

The American Journal of Cardiology

Volume 155, 15 September 2021, Pages 103-112
The American Journal of Cardiology

Impact of Mitral Annular Calcium and Mitral Stenosis on Outcomes After Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2021.06.017Get rights and content

Mitral annular calcium (MAC) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI) and may be associated with mitral stenosis (MAC-MS). Their impact on post-TAVI outcomes remains controversial. We sought to assess the impact of MAC and MAC-MS on clinical outcomes following TAVI. We included 1,177 patients who consecutively underwent TAVI in our institution between January 2008 and May 2018. MAC diagnosis reposed on echocardiogram and computed tomography. The combination of MAC and a mean transmitral gradient ≥ 5 mmHg defined MAC-MS. The study included 1,177 patients, of whom 504 (42.8%) had MAC and 85 (7.2%) had MAC-MS. Patients with and without MAC had similar outcomes except for a higher rate of pacemaker implantation in MAC patients (adjusted HR: 1.32, 95% CI: 1.03-1.69, p = 0.03). The subgroup of patients with severe MAC had similar outcomes. However, MAC-MS was an independent predictor of all-cause mortality at 30 days (adjusted HR: 2.30, 95% CI: 1.08-4.86, p = 0.03) and 1 year (adjusted HR: 1.73, 95% CI: 1.04-2.89, p = 0.04). In conclusion, MAC is present in nearly half of the patients treated with TAVI but MAC-MS is far less frequent. In itself, even severe, MAC does not influence outcomes while MAC-MS is an independent predictor of all-cause 1-year mortality. Measurement of mean transmitral gradient identifies patients with MAC at high risk after TAVI.

Section snippets

Methods

From January 2008 to May 2018, we evaluated 1,239 patients who consecutively underwent TAVI in a French university hospital. We excluded 62 patients because of the presence of a mitral prosthesis in 23 and lack of computed tomography (CT) scan in 39. Thus, the final study population consisted of 1,177 patients. Data were prospectively collected in a local electronic database using the RedCap platform, with the exception of the CT-scan data on MAC, which were retrospectively collected. Patients

Results

Among 1177 patients, 504 (42.8%) had a MAC (Figure 1). Table 1 shows the baseline characteristics and procedural data of the study population according to the presence of MAC. Patients with MAC were more frequently women had a higher prevalence of diabetes, previous chest radiation and porcelain aorta. They more frequently had mitral regurgitation and MS. The procedural findings were similar between groups.

Thirty-day outcomes according to the presence of MAC are shown in Table 2. The rates of

Discussion

The evaluation of combined aortic stenosis and MS is challenging in patients with MAC-MS.19 The continuity equation is flow-dependent and can overestimate MS if concomitant severe aortic stenosis is associated and is not measurable when aortic or mitral regurgitation are present.19 Pressure half-time is unreliable with concomitant aortic stenosis or aortic regurgitation.20 MAC may compromise the accuracy of planimetry. The inflow proximal isovelocity surface area is operator-dependent and

Disclosures

Jules Mesnier is supported by a research grant from the Fédération Française de Cardiologie and received consultancy fees from Owkin

Eric Brochet is proctor for Abbott Vascular

Bernard Iung is consultant for Edwards Lifesciences

Dominique Himbert is proctor for Edwards Lifesciences and Abbott Vascular

The other authors do not declare any disclosure

Cited by (5)

Funding Sources: None.

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