Outcomes Evaluated for TMVR Patients With Severe Mitral Annular Calcification

April 23, 2018—Findings from an evaluation of 1-year outcomes of transcatheter mitral valve replacement (TMVR) in patients with severe mitral annular calcification (MAC) were published by Mayra Guerrero, MD, et al in Journal of the American College of Cardiology (JACC; 2018;71:1841–1853). The investigators conducted a multicenter retrospective review of clinical outcomes data from the multicenter TMVR in MAC Global Registry.

The background of the study is that patients with severe MAC are high risk for surgical mitral valve replacement, and several patients worldwide with severe MAC have beensuccessfully treated with TMVR using balloon-expandable aortic transcatheter valves.

As summarized in JACC, a total of 116 extreme-surgical-risk patients with severe MAC underwent TMVR. There were 106 patients who had a procedure at > 1 year before data lock and were included in the analysis. Patients' mean age was 73 ± 12 years, and 68% were women. The mean Society of Thoracic Surgeons score was 15.3% ± 11.6%, and 90% were New York Heart Association functional class III or IV.

The investigators reported that 30-day and 1-year all-cause mortality was 25% and 53.7%, respectively. Most patients who survived to 30 days were still alive at 1 year (49 of 77 [63.6%]), and the majority (71.8%) were New York Heart Association functional class 1 or 2.

At 1 year, echocardiography data were available for 34 patients, showing that mean left ventricular ejection fraction was 58.6% ± 11.2%, mean mitral valve area was 1.9 ± 0.5 cm², mean mitral gradient was 5.8 ± 2.2 mm Hg, and 75% of these patients had no or trace mitral regurgitation.

The investigators concluded that TMVR with balloon-expandable aortic valves in extreme-surgical-risk patients with severe MAC is feasible but associated with high 30-day and 1-year mortality. Most patients who survived the 30-day postprocedural period were alive at 1 year and have sustained improvement of symptoms and transcatheter valve performance. The role of TMVR in patients with MAC requires further evaluation in clinical trials, advised the investigators in JACC.