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Direct Implantation of Transcatheter Valve in Mitral Annular Calcification: A Multicenter Study

Ali Fatehi Hassanabad1, Mohamad Rabbani2, Derrick Y Tam3

  • 1Section of Cardiac Surgery, Libin Cardiovascular Institute, Calgary, Alberta, Canada.

The Annals of Thoracic Surgery
|October 13, 2024
PubMed

Insights

Direct transcatheter heart valve (THV) implantation is a viable option for severe mitral annular calcification (MAC). This approach showed 30-day and 1-year mortality rates of 9% and 18%, respectively, in high-risk patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe annular calcification (MAC) presents significant risks for mitral valve replacement.
  • Transcatheter heart valve (THV) implantation via a transatrial approach offers a less invasive alternative for high-risk patients.
  • This study evaluates outcomes of direct THV implantation in patients with severe circumferential MAC.

Purpose of the Study:

  • To assess the perioperative and 1-year outcomes of direct transcatheter mitral valve replacement in patients with severe annular calcification.
  • To determine the feasibility and safety of this approach in a Canadian multi-center cohort.

Main Methods:

  • Retrospective chart review of patients with severe circumferential MAC undergoing direct THV implantation between January 2018 and September 2023.
  • Primary outcome measures included 30-day and 1-year mortality and stroke.
  • Secondary outcomes assessed were left ventricular outflow tract obstruction, paravalvular leak (PVL), pressure gradients, and hospital length of stay.

Main Results:

  • Twenty-two patients with severe MAC underwent successful direct THV implantation.
  • Thirty-day mortality was 9% (2 deaths), and 1-year mortality was 18% (4 non-cardiac deaths).
  • One patient experienced a postoperative stroke; 77% had no or trace PVL, and no LVOT obstruction occurred.

Conclusions:

  • Direct THV deployment in severe MAC is a potentially reasonable strategy for carefully selected high-risk patients.
  • The observed mortality rates suggest this approach should be reserved for individuals unsuitable for conventional surgical methods.
  • This technique may offer a valuable alternative when traditional mitral valve surgery is contraindicated.
Abstract

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