Mitral annular calcium not tied to worse outcomes in TAVR
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The presence of mitral annular calcium was not associated with worse outcomes in patients who had transcatheter aortic valve replacement, according to a retrospective analysis.
“There are many patients with aortic stenosis that have mitral annular calcium (MAC),” Samir R. Kapadia, MD, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic and professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, told Healio. “It has been shown in other studies that patients with MAC undergoing cardiac surgery (even aortic valve replacement alone) have worse outcomes compared to patients without MAC. There is possibility that patients with MAC have similarly worse outcomes with TAVR also, and therefore we wanted to understand this patient population. The reason to believe that MAC may have worse outcomes is its association with aortic calcification, may be increased paravalvular leak due to extent of calcium in the heart, and possible mitral valve disease.”
Kapadia and colleagues retrospectively analyzed 468 patients who underwent TAVR with a balloon-expandable valve (Sapien 3, Edwards Lifesciences) in 2018 at Cleveland Clinic. Patients were stratified by whether they had MAC; 58% did, with 15% having severe MAC.
Compared with those without MAC, those with it were older (P = .012), had higher BMI (P = .031), had lower left ventricular end-diastolic diameter (P < .001), had higher mitral valve mean gradient (P = .031) and had a trend toward a higher Society of Thoracic Surgeons risk score (P = .127), according to the researchers.
There were no differences between those with and without MAC in the following outcomes:
- 1-year mortality (MAC, 9%; no MAC, 6%; P = .8);
- 2-year mortality (MAC, 15%; no MAC, 13%; P = .47);
- 1-year MI (MAC, 1%; no MAC, 2%; P = .417);
- 1-year stroke (MAC, 1%; no MAC, 3%; P = .4); and
- 1-year MACCE (MAC, 17%; no MAC, 19%; P = .53).
The groups were also not different in atrioventricular block (P = .483), need for pacemaker implantation (P = .168) and postprocedural peak aortic valve gradient (P = .931), according to the researchers.
“The reason we did not find the difference is the fact the procedure was accomplished with no more paravalvular leak, permanent pacemaker implantation or stroke — complications that we feared would be higher in patients with MAC,” Kapadia told Healio. “This is thanks to the newer TAVR devices and our ability to precisely deliver TAVR valves. Careful procedural planning makes this possible. TAVR provides a great option for patients with MAC and aortic stenosis.”
For more information:
Samir R. Kapadia, MD, can be reached at kapadis@ccf.org.
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