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Effect of Mitral Annular Calcification on Outcomes Following Transcatheter Aortic Valve Replacement

Takura Taguchi1, Koichi Maeda1, Yusuke Yanagino1

  • 1Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine, Osaka, Japan.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|December 5, 2025
PubMed
Abstract

Insights

Mitral annular calcification (MAC) severity does not impact survival after transcatheter aortic valve replacement (TAVR). However, MAC in the A3 segment predicts pacemaker implantation, not overall MAC severity.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Mitral annular calcification (MAC) is common in patients undergoing transcatheter aortic valve replacement (TAVR).
  • The prognostic significance of MAC severity and its specific anatomical distribution on TAVR outcomes is not well understood.

Purpose of the Study:

  • To investigate the impact of MAC severity and anatomical distribution on outcomes after TAVR.
  • Specifically, to determine if MAC characteristics predict mortality and the need for pacemaker implantation.

Main Methods:

  • Retrospective analysis of 642 patients undergoing TAVR (2016-2021).
  • Exclusion of patients with prior permanent pacemaker implantation.
  • Assessment of MAC severity and segmental distribution via preprocedural CT scans.

Main Results:

  • Severe MAC was present in 15% of patients; 10.9% required new pacemakers, and 24.6% died within 3 years.
  • No significant difference in 3-year survival rates across MAC severity groups.
  • MAC localization in the A3 segment, not overall severity, independently predicted pacemaker implantation (OR 5.10, p < 0.001).

Conclusions:

  • MAC severity does not independently predict mortality or pacemaker need post-TAVR.
  • Localization of MAC within the A3 segment is a significant independent predictor of conduction disturbances requiring pacemaker implantation after TAVR.
Keywords:
complete atrioventricular blockmitral annular calcificationmitral valve diseasetranscatheter aortic valve replacement

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