Key result
Mitral annular calcification in patients undergoing mitral valve surgery was associated with similar perioperative mortality (RR 1.15; 95% CI 0.50-2.65) but greater midterm mortality (IRR 1.32).
Why the study?
Mitral valve disease with mitral annular calcification poses a surgical challenge, and clinical outcomes of mitral valve surgery and transcatheter mitral valve replacement remain relatively unexplored.
Do mitral valve interventions (surgery or TMVR) result in worse clinical outcomes in patients with mitral annular calcification compared to those without?
Meta-Analysis (n=2,902)
Do mitral valve interventions (surgery or TMVR) result in worse clinical outcomes in patients with mitral annular calcification compared to those without?
Relative Risk: 1.15 (95% CI 0.5–2.65)
p-value: p=.74
Mitral valve interventions in patients with mitral annular calcification carry significantly higher morbidity and mortality compared to non-MAC patients, highlighting the need for careful patient selection.
MAC patients may warrant closer midterm surveillance after mitral surgery; leaves open whether TMVR modifies this association.
BACKGROUND: Mitral valve (MV) disease with mitral annular calcification (MAC) poses a surgical challenge and the clinical outcomes of MV surgery as well as transcatheter mitral valve replacement (TMVR) remain relatively unexplored. We performed a systematic review and meta-analysis to assess the effects of MAC on clinical outcomes following MV surgery and TMVR. METHODS: We searched MEDLINE and EMBASE databases until February 2019 for studies comparing clinical outcomes of MV surgery or TMVR in patients with and without MAC. Data were extracted by two independent investigators. Outcomes were perioperative and midterm complications and mortality. RESULTS: Seven observational studies enrolling 2902 patients were included. MAC patients were older, more likely to be female with greater chronic lung disease and kidney failure. Perioperative mortality was similar between patients with and without MAC undergoing MV surgery (risk ratio [RR], 1.15; 95% confidence interval [CI], 0.50-2.65; P = .74). MAC was associated with a higher risk of bleeding, permanent pacemaker implantation, and periprosthetic leak. Midterm mortality was greater in MAC patients undergoing MV surgery (incident rate ratio [IRR], 1.32; 95% CI, 1.05-1.67; P = .02). MAC patients undergoing TMVR had higher perioperative (RR, 4.65; 95% CI, 2.93-7.38; P < .01) and 1-year (RR, 5.44; 95% CI, 3.49-8.49; P < .01) mortality, decreased procedural success, greater left ventricular outflow tract obstruction and need for conversion to surgery when compared with patients undergoing TMVR for dysfunction of a bioprosthetic valve or annuloplasty ring. CONCLUSION: MV procedures in patients with MAC are associated with higher mortality and morbidity. This is largely driven by the high-risk patient profile associated with MAC. TMVR holds promise but has important limitations and should be reserved for select patients.
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Ribeiro et al. (2019) conducted a meta-analysis in Mitral valve disease undergoing MV surgery or TMVR (n=2,902). Mitral annular calcification vs. Without mitral annular calcification was evaluated on Perioperative mortality (MV surgery) (RR 1.15, 95% CI 0.50-2.65, p=.74). Mitral annular calcification in patients undergoing mitral valve surgery was associated with similar perioperative mortality (RR 1.15; 95% CI 0.50-2.65) but greater midterm mortality (IRR 1.32).
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