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Investigating Aortic Valve Calcification via Isolation and Culture of T Lymphocytes using Feeder Cells from Irradiated Buffy Coat
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Extensive calcification of the mitral valve annulus in transcatheter aortic valve implants

Martin Haensig1, Thomas Kuntze1, David Lopez Gonzalez1

  • 1Department of Cardiothoracic Surgery, Central Clinic Hospital of Bad Berka, Bad Berka, Germany.

Interactive Cardiovascular and Thoracic Surgery
|October 3, 2021
PubMed

Insights

Mitral annular calcification (MAC) affects 43% of patients undergoing transcatheter aortic valve implantation. Severe MAC increases risks of paravalvular leaks and mortality, suggesting oversized self-expandable valves may improve outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Mitral annular calcification (MAC) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI).
  • The implications of MAC on procedural and safety outcomes in TAVI are not fully understood.
  • Understanding MAC patterns can optimize TAVI procedures and patient management.

Purpose of the Study:

  • To investigate the calcification pattern of the mitral valve annulus in TAVI patients.
  • To evaluate the impact of MAC on procedural and safety outcomes, including paravalvular leaks, arrhythmias, and mortality.
  • To provide recommendations for managing severe MAC during TAVI.

Main Methods:

  • Retrospective analysis of 305 patients who underwent TAVI between November 2018 and September 2019.
  • Assessment of mitral annular calcification extent and pattern.
  • Evaluation of safety outcomes, including paravalvular leaks, arrhythmias, and 30-day mortality.

Main Results:

  • Prevalence of MAC was 43%.
  • Severe circumferential MAC was associated with moderate paravalvular leaks (63%), right bundle branch block (OR 2.01), and low cardiac output (OR 3.12).
  • Subannular calcification increased risk of left ventricular outflow tract injury (OR 3.54) with balloon-expandable valves and was linked to rhythm disorders and female gender.

Conclusions:

  • Extensive MAC is linked to moderate paravalvular leaks, impacting prosthesis size and survival in TAVI.
  • In severe MAC cases, implanting oversized self-expandable prostheses is recommended to mitigate risks of right bundle branch block and paravalvular leaks.
Abstract

Keywords:
Calcification pathologyMitral valve annulusTranscatheter aortic valve implantation

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