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Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular Calcification: A Systematic Review

Sophia L Alexis1, Aaqib H Malik2, Ahmed El-Eshmawi1

  • 1Department of Cardiovascular Surgery Mount Sinai Health System New York NY.

Journal of the American Heart Association
|March 17, 2021
PubMed

Insights

Transcatheter mitral valve replacement (TMVR) offers a promising alternative to surgical mitral valve replacement (SMVR) for high-risk patients with mitral annular calcification. While TMVR shows comparable early outcomes, further research is needed to optimize technology and long-term results.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Mitral annular calcification (MAC) with mitral valve disease presents significant challenges, often requiring surgical mitral valve replacement (SMVR).
  • Transcatheter mitral valve replacement (TMVR) is an emerging alternative for high-risk individuals with suitable anatomy.

Purpose of the Study:

  • To compare the outcomes of TMVR and SMVR in patients with mitral annular calcification.
  • To evaluate the feasibility and early results of different TMVR approaches.

Main Methods:

  • A systematic review of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted.
  • Data from 27 selected articles were analyzed, focusing on patients who underwent SMVR or TMVR (transatrial, transapical, or transseptal).

Main Results:

  • TMVR patients were older with higher surgical risk scores compared to SMVR patients.
  • Median follow-up for TMVR was shorter (9-12 months) than for SMVR (54 months).
  • In-hospital, 30-day, and 1-year mortality rates for TMVR varied by approach but were significant, while SMVR showed a wide range of early and long-term mortality.

Conclusions:

  • TMVR, particularly with the transatrial approach, presents a viable option for high-risk patients with challenging anatomy, offering an alternative to SMVR.
  • Further research is essential to enhance TMVR technology, patient selection, surgical expertise, and long-term outcome data.

Keywords:
mitral annulus calcificationmitral valvemitral valve replacementtranscatheter

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