Key result
Mitral annular calcification did not significantly increase in-hospital mortality (OR 1.77) in TAVI patients, but increased permanent pacemaker implantations and paravalvular aortic regurgitation.
Why the study?
Mitral annular calcification is commonly observed and linked to adverse outcomes, but its prevalence and impact on peri-procedural, in-hospital, and long-term outcomes in high-surgical-risk patients with severe AS undergoing TAVI needed clarification.
Does the presence of mitral annular calcification impact peri-procedural, in-hospital, and long-term outcomes in high-surgical-risk patients with severe aortic stenosis undergoing TAVI?
Cohort (n=403)
No
Does the presence of mitral annular calcification impact peri-procedural, in-hospital, and long-term outcomes in high-surgical-risk patients with severe aortic stenosis undergoing TAVI?
Odds Ratio: 1.77 (95% CI 0.88–3.54)
Absolute Event Rate: 11.5% vs 6.8%
p-value: p=0.106
In patients undergoing TAVI for severe aortic stenosis, concomitant mitral annular calcification does not independently predict mortality but significantly increases the risk of permanent pacemaker implantation and paravalvular aortic regurgitation.
MAC may signal higher TAVI risk; leaves open whether it independently predicts outcomes in prospective studies.
Introduction: Mitral annular calcification (MAC) is commonly observed in patients with cardiovascular diseases and has been associated with adverse clinical outcomes.This study aims to clarify the prevalence and impact of MAC on peri-procedural, in-hospital, and longterm outcomes in high-surgical-risk patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).Materials and Methods: 403 patients underwent TAVI for severe AS was retrospectively evaluated.MAC was identified on transthoracic-echocardiography and confirmed on computed-tomography in 45.4% of patients.Clinical outcomes, including in -hospital mortality and two-year follow-up mortality, were evaluated, and potential predictors of MAC and mortality were analyzed using logistic and Cox regression models.Results : MAC was more prevalent in older, female patients with atrial fibrillation.Although the presence of MAC did not co rrelate with increased in-hospital (unadj OR: 1.77, 95% CI (0.88-3.54)) or long-term mortality (unadj OR: 0.73, 95% CI (0.40-1.33)), it was associated with a higher requirement for post-TAVI permanent pacemaker implantation (PPI) and moderate-to-severe paravalvular aortic regurgitation (PVAR).Multivariate analysis revealed left ventricular ejection fraction (adj HR: 0.97, 95% CI (0.94-0.99)), mean transvalvular gradient, (adj HR: 1.02, 95% CI (1.00-1.04))systolic pulmonary artery pressure (adj HR: 1.04, 95% CI (1.01-1.0.6)) and severe PVAR (adj HR: 3.16, 95% CI (1.25-7.96))as independent predictors of long-term mortality. Conclusion:In patients with severe AS undergoing TAVI, MAC is a marker of complex cardiac pathology but does not independently predict mortality.However, its presence may increase the need for PPI and the incidence of PVAR, which warrants attention in postoperative management and follow-up.
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Hakgör et al. (2024) conducted a cohort in Severe aortic stenosis (n=403). Mitral annular calcification vs. Without mitral annular calcification was evaluated on In-hospital mortality (OR 1.77, 95% CI 0.88-3.54, p=0.106). Mitral annular calcification did not significantly increase in-hospital mortality (OR 1.77) in TAVI patients, but increased permanent pacemaker implantations and paravalvular aortic regurgitation.
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