Mitral annular calcification in TAVI patients was associated with higher rates of pericardial effusion (26.4% vs 12.4%), and severe MAC independently predicted all-cause mortality (HR 1.94, p=0.024).
Observational (n=245)
Does the presence and severity of mitral annular calcification affect procedural and clinical outcomes in patients undergoing self-expanding TAVI?
Severe mitral annular calcification and its extension into the left ventricular outflow tract are significant predictors of mortality and the need for permanent pacemaker implantation following self-expanding TAVI.
Absolute Event Rate: 26.4% vs 12.4%
p-value: p=0.013
Background and Objectives: Transcatheter aortic valve implantation (TAVI) is the standard therapy for patients with severe aortic stenosis at intermediate or high surgical risk. Mitral annular calcification (MAC) is frequently observed in this population and has been linked to adverse cardiovascular outcomes. This study evaluated the association between MAC and TAVI-related complications and mortality, and identified predictors of all-cause mortality and permanent pacemaker implantation (PPI) following TAVI. Materials and Methods: Patients undergoing self-expanding TAVI between January 2010 and June 2020 were retrospectively analyzed. Outcomes included TAVI-related complications, in-hospital and long-term mortality, and predictors of all-cause mortality and PPI. Results: A total of 245 patients (98 men 40%, mean age 76.3 ± 8.3 years) were included. Mean left ventricular ejection fraction was 54.8 ± 11.4%, and aortic valve area was 0.74 ± 0.14 cm2. MAC was present in 148 patients (60.4%). Pericardial effusion (26.4% vs. 12.4%, p = 0.013) and acute kidney injury (21.6% vs. 7.2%, p = 0.005) were significantly more frequent in patients with MAC. PPI was required in 42 patients (17.8%). In-hospital mortality occurred in 14 patients (5.7%), and all-cause mortality was observed in 89 patients (36.3%) during a median follow-up of 23.1 months (IQR, 11.6–44.3). MAC extension into the left ventricular outflow tract was the only independent predictor of PPI (OR: 3.32, p = 0.002). Independent predictors of all-cause mortality included use of renin–angiotensin–aldosterone system blockers (HR: 0.54, p = 0.012), hemoglobin level (HR: 0.79, p = 0.006), severe MAC (HR: 1.94, p = 0.024), and post-TAVI atrial fibrillation (HR: 2.39, p = 0.002). Conclusions: MAC is common in TAVI patients and is associated with increased procedural complications, including higher rates of pericardial effusion and acute kidney injury. Greater MAC severity independently predicts higher all-cause mortality. In addition, MAC extension into the left ventricular outflow tract is an independent predictor of PPI following self-expanding TAVI, emphasizing the importance of comprehensive pre-procedural imaging.
Şener et al. (Mon,) conducted a observational in Severe aortic stenosis at intermediate or high surgical risk (n=245). Mitral annular calcification (MAC) vs. No MAC was evaluated on Pericardial effusion (p=0.013). Mitral annular calcification in TAVI patients was associated with higher rates of pericardial effusion (26.4% vs 12.4%), and severe MAC independently predicted all-cause mortality (HR 1.94, p=0.024).