Transcatheter edge-to-edge mitral valve repair in patients with mitral annulus calcification

Fernández-Peregrina, Estefanía; Pascual, Isaac; Freixa, Xavier; Tirado‐Conte, Gabriela; Estévez‐Loureiro, Rodrigo; Carrasco-Chinchilla, Fernando; Benito‐González, Tomas; Asmarats, Lluís; Sanchís, Laura; Jiménez‐Quevedo, Pilar; Avanzas, Pablo; Caneiro‐Queija, Berenice; Molina-Ramos, Ana Isabel; Fernández‐Vázquez, Felipe; Li, Chi-Hion; Flores‐Umanzor, Eduardo; Sans‐Roselló, Jordi; Nombela‐Franco, Luis; Arzamendi, Dabit

doi:10.4244/eij-d-21-00205

Cited by 15 publications

(18 citation statements)

References 39 publications

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“…Second, missing data regarding postprocedural MR grade and NYHA class may have interfered with the interpretation of results. However, data availability was comparable in all groups and subgroups, similar to that mentioned in the recent multicenter report, 12 and prognostically nonsignificant, all limiting the probability of bias. Also, mortality, hospitalizations, and reinterventions status were known in all patients.…”

Section: Limitationssupporting

confidence: 70%

“…The first is that mitral TEER, when performed in selected patients and at a high-volume center, is feasible, safe, and efficacious irrespective of MAC extent. Notably, the postprocedural course experienced by patients with above-mild MAC in the present study was apparently more favorable compared with that reported by the abovementioned multicenter registry, 12 in which increased rates of 1-year deaths (19.0% versus 11.9%) and HF hospitalizations (21.1% versus 17.8%) were observed. Similarly, significant MAC in our experience did not affect interventional times and complication rate, which proved higher in patients with versus without MAC undergoing surgical MV interventions and transcatheter MV replacement.…”

Section: Discussioncontrasting

confidence: 51%

“…In the first, 11 encompassing 173 cases treated at our institution during 2009 to 2014 with the then-investigational, early-generation MitraClip, patients with and without above-mild MAC exhibited similar technical success rates, residual MR and functional status, and cumulative incidence of subsequent MV surgery at 1 year. A more recent, 852-patient multicenter study 12 reported higher rates of surgical conversion and 1-year deaths among patients with above-mild MAC, as well as a marginal association between above-mild MAC and mortality (hazard ratio, 2.0 [95% CI, 0.9–4.3]; P =0.070), with no effect of MAC degree on residual MR and functional disability. Noteworthy, patients with above-mild MAC (7.2%) and primary MR (30.7%) were underrepresented, those with calcification extending to leaflet tips or TMPG of >5 mm Hg were excluded, and multivariable analysis details were not disclosed.…”

Section: Discussionmentioning

confidence: 97%

“…Randomized clinical trials have excluded patients with any 8 or severe 9,10 MAC, whereas real-world studies either reflected early, small-scale experience with the procedure 11 or evaluated individual, noncomposite outcomes not adjusted for baseline MR cause. 12 By using a contemporary, large sample and expanding the scope of analysis, we aimed to validate the results of these previous works and elaborate on the prognostic value of significant (ie, above-mild) MAC in patients undergoing TEER for all-cause, functional, and primary MR.…”

mentioning

confidence: 93%

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Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair

Shechter,

Lee,

Kaewkes

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: Limited data exist regarding the impact of mitral annular calcification (MAC) on outcomes of transcatheter edge-to-edge repair for mitral regurgitation (MR). METHODS: We retrospectively analyzed 968 individuals (median age, 79 [interquartile range, 70–86] years; 60.0% males; 51.8% with functional MR) who underwent an isolated, first-time intervention. Stratified by MAC extent per baseline transthoracic echocardiogram, the cohort was assessed for residual MR, functional status, all-cause mortality, heart failure hospitalizations, and mitral reinterventions post-procedure. RESULTS: Patients with above-mild MAC (n=101; 10.4%) were older and more likely to be female, exhibited a greater burden of comorbidities, and presented more often with severe, primary MR. Procedural aspects and technical success rate were unaffected by MAC magnitude, as was the significant improvement from baseline in MR severity and functional status along the first postprocedural year. However, the persistence of above-moderate MR or functional classes III and IV at 1 year and the cumulative incidence of reinterventions at 2 years were overall more pronounced within the above-mild MAC group (significant MR or functional impairment, 44.7% versus 29.9%, P =0.060; reinterventions, 11.9% versus 6.2%, P =0.033; log-rank P =0.035). No link was demonstrated between MAC degree and the cumulative incidence or risk of mortality and mortality or heart failure hospitalizations. Differences in outcomes frequencies were mostly confined to the primary MR subgroup, in which patients with above-mild MAC also experienced earlier, more frequent 2-year heart failure hospitalizations (20.8% versus 9.6%; P =0.016; log-rank P =0.020). CONCLUSIONS: Mitral transcatheter edge-to-edge repair in patients with and without above-mild MAC is equally feasible and safe; however, its postprocedural course is less favorable among those with primary MR.

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Section: Limitationssupporting

confidence: 70%

Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 93%

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Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair

Shechter,

Lee,

Kaewkes

et al. 2024

Circ: Cardiovascular Interventions

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“…However, two case series of 28 and 61 patients with moderate to severe MAC undergoing TEER did not find significant differences in procedural success when compared with patients with non-MAC. In one of these studies, 1-year mortality trended to be higher in patients with MAC (19.7% vs 11.3%, p=0.050) 31 32. In summary, data on TEER in patients with MAC are extremely limited and further studies are needed.…”

Section: Introductionmentioning

confidence: 97%

Management of valve dysfunction in patients with mitral annular calcification

Demal

Conradi

2023

Heart

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Contemporary experience of mitral transcatheter edge‐to‐edge repair technology in patients with mitral annular calcification

Mustafa,

Basman,

Cinelli

et al. 2024

Cathet Cardio Intervent

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BackgroundMitral annular calcification (MAC) has been an exclusion for many of the earlier pivotal trials that were instrumental in gaining device approval and indications for mitral transcatheter edge‐to‐edge repair (M‐TEER).AimsTo evaluate the impact of MAC on the procedural durability and success of newer generation MitraClip® systems (G3 and G4 systems).MethodsData were collected from Northwell TEER registry. Patients that underwent M‐TEER with third or fourth generation MitraClip device were included. Patients were divided into −MAC (none‐mild) and +MAC (moderate‐severe) groups. Procedural success was defined as ≤ grade 2 + mitral regurgitation (MR) postprocedure, and durability was defined as ≤ grade 2 + MR retention at 1 month and 1 year. Univariate analysis compared outcomes between groups.ResultsOf 260 M‐TEER patients, 160 were −MAC and 100 were +MAC. Procedural success was comparable; however, there were three patients who required conversion to cardiac surgery during the index hospitalization in the +MAC group versus none in the −MAC group (though this was not statistically significant). At 1‐month follow‐up, there were no significant differences in MR severity. At 1‐year follow‐up, +MAC had higher moderate‐severe MR (22.1% vs. 7.5%; p = 0.002) and higher mean transmitral gradients (5.3 vs. 4.0 mmHg; p = 0.001) with no differences in mortality, New York Heart Association functional class or ejection fraction.ConclusionIn selective patients with high burden of MAC, contemporary M‐TEER is safe, and procedural success is similar to patients with none‐mild MAC. However, a loss of procedural durability was seen in +MAC group at 1‐year follow‐up. Further studies with longer follow‐ups are required to assess newer mTEER devices and their potential clinical implications in patients with a high burden of MAC.

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Transcatheter edge-to-edge mitral valve repair in patients with mitral annulus calcification

Cited by 15 publications

References 39 publications

Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair

Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair

Management of valve dysfunction in patients with mitral annular calcification

Contemporary experience of mitral transcatheter edge‐to‐edge repair technology in patients with mitral annular calcification

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