MAC ≥180° and aortic knob calcification ≥180° were each associated with significantly higher 10-year mortality post-AVR (52.1% vs 40.7%, 64.4% vs 35.3%, respectively).
Does the presence of mitral annular or aortic calcification increase long-term mortality in patients undergoing surgical or transcatheter aortic valve replacement for severe aortic stenosis?
In patients undergoing aortic valve replacement for severe aortic stenosis, the presence of significant mitral annular or aortic calcification is associated with increased 10-year mortality.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction Mitral annular calcification (MAC) and aortic calcification are frequently observed in patients with severe aortic stenosis (AS). MAC is not only a well-known degenerative atherosclerotic process but also a surrogate marker of dysregulated calcium-phosphate metabolism, mechanical stress, and inflammatory processes. While the impact of MAC or aortic calcification on mortality following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) has been explored, most studies have focused on short-term outcomes, and data on long-term survival remain limited. Purpose This study aimed to retrospectively investigate whether severe AS complicated by MAC (upstream) or aortic calcification (downstream) is associated with increased long-term mortality following AVR. Methods We included all patients who underwent SAVR or TAVR for severe AS at our institution. MAC was assessed using preoperative computed tomography (CT) scans. MAC severity was classified as mild (180°), moderate (180°–270°), or severe (270°) based on the extent of annular involvement. Aortic calcification was qualitatively evaluated using chest X-rays, specifically assessing calcification of the aortic knob. The severity was categorized as grade 1 (90°), grade 2 (90°–180°), grade 3 (180°–270°), or grade 4 (270°). Survival analysis was performed based on the presence of MAC, MAC severity (≥ moderate), and the degree of aortic knob calcification (≥ 180°). Results Among a total of 638 patients (SAVR: 518, TAVR: 120), 133 patients (20.8%) had MAC. The distribution of MAC severity was as follows: mild in 103 patients (77.4%), moderate in 17 patients (12.8%), and severe in 13 patients (9.8%). Aortic calcification was observed in 400 patients (62.7%), with grade 1 in 159 (39.7%), grade 2 in 85 (21.2%), grade 3 in 92 (23.0%), and grade 4 in 64 (16.0%). There was a significant association between MAC (grade ≥ 2) and aortic knob calcification (p 0.001). The 10-year mortality was significantly higher in patients with MAC compared to those without (55.9% vs. 38.5%, p = 0.006). When stratified by MAC severity (≥180° vs. 180°), mortality rates were 52.1% vs. 40.7% (p = 0.027). Similarly, for aortic knob calcification, patients with calcification ≥180° vs. 180° showed a significant mortality difference (64.4% vs. 35.3%, p 0.001). Conclusion In patients with severe AS, MAC ≥180° and aortic calcification assessed by aortic knob imaging were significantly associated with each other and with increased long-term mortality following AVR. These findings highlight the prognostic implications of annular and aortic calcification in the management of severe AS.
Kim et al. (Sat,) reported a other. MAC ≥180° and aortic knob calcification ≥180° were each associated with significantly higher 10-year mortality post-AVR (52.1% vs 40.7%, 64.4% vs 35.3%, respectively).