Key result
MAC and extensive aortic arch calcification fail to predict long-term mortality after AVR.
Why the study?
Does the presence of mitral annular calcification or extensive aortic arch calcification independently predict mortality in patients with severe aortic stenosis undergoing aortic valve replacement?
Cohort (n=636)
No
Does the presence of mitral annular calcification or extensive aortic arch calcification independently predict mortality in patients with severe aortic stenosis undergoing aortic valve replacement?
Mitral annular calcification and aortic arch calcification are markers of advanced age and comorbidity rather than independent determinants of post-AVR survival, suggesting these patients should not be excluded from life-saving AVR therapies.
May support AVR eligibility regardless of these calcifications; leaves open their prognostic value in non-AVR severe AS populations.
BACKGROUND AND OBJECTIVES: Patients with severe aortic stenosis (AS) often have mitral annular calcification (MAC) and aortic arch calcification (AAC). We investigated the clinical significance of a MAC and extensive AAC in patients with AS requiring aortic valve replacement (AVR). METHODS: We retrospectively analyzed 636 patients with severe AS who underwent AVR (surgical or transcatheter) at our institution. Preoperative echocardiography and computed tomography were used to identify MAC, and chest radiographs were reviewed for AAC. RESULTS: Of the 636 patients, 133 (20.9%) had MAC, while 156 (24.5%) had extensive AAC (≥180°). Patients with MAC were older and more often female, with higher Society of Thoracic Surgeons scores and greater comorbidities. Over a median follow-up of 5.2 years, 157 patients (24.7%) died. In univariate analysis, the presence of any MAC and extensive AAC was associated with significantly higher mortality. In multivariable analysis, however, neither was an independent predictor of mortality. Instead, age, male sex, diabetes mellitus, chronic kidney disease (eGFR <60 mL/min/1.73 m²), and dialysis emerged as independent risk factors. CONCLUSIONS: MAC and extensive AAC identify a subset of patients with severe AS who are older and have more comorbid disease. Management of such patients should focus on optimizing overall risk factors, and the presence of MAC or AAC alone should not exclude patients from life-saving AVR therapies.
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Kim et al. (2026) conducted a cohort in Severe aortic stenosis (n=636). Mitral annular calcification (MAC) vs. No mitral annular calcification was evaluated on All-cause mortality (HR 0.92, 95% CI 0.60-1.43, p=0.72). In patients with severe aortic stenosis undergoing aortic valve replacement, neither mitral annular calcification (HR 0.92) nor extensive aortic arch calcification (HR 1.24) were independent predictors of long-term mortality after multivariable adjustment.
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