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Published on: October 16, 2021
Transcatheter Mitral Valve Replacement in Patients with Mitral Annular Calcification: A Review
Ankit Agrawal1, Michael J Reardon2, Sachin S Goel2
1Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract:
Mitral annular calcification (MAC) is a progressive degenerative calcification of the mitral valve (MV) that is associated with mitral stenosis, regurgitation or both. Patients with MAC are poor candidates for MV surgery because of technical challenges and high peri-operative mortality. Transcatheter MV replacement (TMVR) has emerged as an option for such high surgical risk patients. This has been described with the use of the SAPIEN transcatheter heart valve (valve-in-MAC) and dedicated TMVR devices. Careful anatomic assessment is important to avoid complications of TMVR, such as left ventricular outflow tract obstruction, valve migration, embolization and paravalvular mitral regurgitation. In this review, we discuss the pathology, importance of preprocedural multimodality imaging for optimal patient selection, clinical outcomes and complications associated with TMVR in patients with MAC.
Insights
Mitral annular calcification (MAC) poses surgical risks. Transcatheter mitral valve replacement (TMVR) offers an alternative for high-risk patients, but requires careful imaging to prevent complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Mitral annular calcification (MAC) is a degenerative condition affecting the mitral valve (MV).
- MAC is linked to mitral stenosis and/or regurgitation.
- Patients with MAC often face high risks with traditional mitral valve surgery.
Purpose of the Study:
- To review the pathology of MAC.
- To highlight the role of preprocedural imaging in patient selection for TMVR.
- To discuss clinical outcomes and complications of TMVR in MAC patients.
Main Methods:
- Review of existing literature on transcatheter mitral valve replacement (TMVR) in MAC.
- Emphasis on multimodality imaging for anatomical assessment.
- Analysis of clinical outcomes and complication profiles.
Main Results:
- TMVR, including valve-in-MAC, is a viable option for high-risk surgical patients.
- Thorough preprocedural imaging is crucial for successful TMVR.
- Potential complications include left ventricular outflow tract obstruction and paravalvular regurgitation.
Conclusions:
- TMVR provides a treatment alternative for patients with MAC unsuitable for surgery.
- Optimal patient selection via imaging is key to minimizing TMVR risks.
- Understanding MAC pathology and TMVR complications is essential for interventional cardiologists.
