Why the study?
Patients with mitral annular calcification are poor candidates for mitral valve surgery due to technical challenges and high peri-operative mortality, making transcatheter mitral valve replacement an emerging alternative.
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TMVR offers a potential therapeutic option for high-surgical-risk patients with severe mitral annular calcification, but requires meticulous preprocedural multimodality imaging to mitigate severe complications like LVOT obstruction.
Mitral annular calcification (MAC) is a progressive degenerative calcification of the mitral valve (MV) that is associated with mitral stenosis, regurgitation or both. Patients with MAC are poor candidates for MV surgery because of technical challenges and high peri-operative mortality. Transcatheter MV replacement (TMVR) has emerged as an option for such high surgical risk patients. This has been described with the use of the SAPIEN transcatheter heart valve (valve-in-MAC) and dedicated TMVR devices. Careful anatomic assessment is important to avoid complications of TMVR, such as left ventricular outflow tract obstruction, valve migration, embolization and paravalvular mitral regurgitation. In this review, we discuss the pathology, importance of preprocedural multimodality imaging for optimal patient selection, clinical outcomes and complications associated with TMVR in patients with MAC.
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Agrawal et al. (2023) studied this question.
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