What is the clinical evidence from this study?

Study design: Observational. Population: Severe mitral annular calcification and failing ring repairs (n=40). Intervention: Transcatheter mitral valve replacement (TMVR). Primary outcome: Technical success according to Mitral Valve Academic Research Consortium criteria.

What does this research mean for the field?

Transcatheter mitral valve replacement for mitral annular calcification or failing rings achieves technical success in 63% of patients and significantly reduces the mitral valve gradient, though it carries notable complication risks and frequently requires adjunctive techniques. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate in-hospital and 30-day outcomes of commercial transcatheter mitral valve replacement (TMVR) in patients with severe mitral annular calcification or prior surgical rings using contemporary adjunctive techniques.

September 30, 2020JACC: Cardiovascular InterventionsOpen Access

Contemporary Transcatheter Mitral Valve Replacement for Mitral Annular Calcification or Ring

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Key result

TMVR for MAC or failing rings achieves ~63% technical success and reduces mitral valve gradients.

n=40

Why the study?

TMVR is evolving as a treatment option for severe mitral annular calcification and failing ring repairs, but the use of adjunctive techniques like anterior mitral leaflet laceration and alcohol septal ablation is not well studied in clinical practice.

Comparison

Valve-in-mitral annular calcification vs valve-in-ring TMVR with adjunctive techniques

Design

Single-center observational study

Follow-up

30 days

Authors

JTJasleen K TiwanaAlaska Heart and Vascular Institute GAGabriel S. AldeaUniversity of Washington DLDmitry LevinUniversity of Maryland, Baltimore

Discussion

Member takes

Implication

TMVR with adjunctive LAMPOON and pre-emptive ASA shows moderate technical success in high-risk ViMAC/ViRing cases; leaves open the need for dedicated devices and prospective trials.

Key Points

To evaluate in-hospital and 30-day outcomes of commercial transcatheter mitral valve replacement (TMVR) in patients with severe mitral annular calcification or prior surgical rings using contemporary adjunctive techniques.
Conducted a single-center observational study of 40 patients undergoing TMVR between September 2015 and April 2020.
Categorized patients into valve-in-mitral annular calcification (ViMAC, N=28) and valve-in-ring (ViRing, N=12) cohorts.
Tracked adjunctive procedures—including anterior mitral leaflet laceration (LAMPOON) and pre-emptive alcohol septal ablation—and assessed outcomes at 30 days based on Mitral Valve Academic Research Consortium criteria.
Technical success was achieved in 63% of patients overall (75% ViRing vs. 57% ViMAC), with 30-day mortality occurring in 21% of the ViMAC group (6/28) and 0% of the ViRing group.
Left ventricular outflow tract obstruction occurred in 13% of patients overall (14% ViMAC vs. 8% ViRing), and valve embolization or late migration occurred in 13% (4 ViMAC, 1 ViRing).
At 30 days, mean mitral valve gradient was significantly reduced from baseline (5.5 ± 2.1 mm Hg vs. 10.6 ± 4.8 mm Hg; p < 0.01), with 8% exhibiting moderate or greater residual mitral regurgitation.

Study Design

Type

Observational (n=40)

Multicenter

Structured PICO

Population

40 patients undergoing transcatheter mitral valve replacement for severe mitral annular calcification or failing ring repairs, assessed for in-hospital and 30-day outcomes.

Exposure

Transcatheter mitral valve replacement (TMVR) using contemporary techniques, including concomitant laceration of the anterior mitral valve leaflet and pre-emptive alcohol septal ablation

Outcome

In-hospital and 30-day outcomes, including technical success according to Mitral Valve Academic Research Consortium (MVARC) criteriacomposite

Transcatheter mitral valve replacement for mitral annular calcification or failing rings is feasible and reduces mitral valve gradients, but it is associated with significant procedural risks and frequently requires complex adjunctive techniques.

Cite This Study

Tiwana et al. (2020) conducted an observational in Severe mitral annular calcification and failing ring repairs (n=40). Transcatheter mitral valve replacement (TMVR) was evaluated on Technical success according to Mitral Valve Academic Research Consortium criteria. Transcatheter mitral valve replacement for mitral annular calcification or failing rings achieved technical success in 63% of patients and significantly reduced the mitral valve gradient (P<0.01).

synapsesocial.com/papers/6aadebdd64f913cc7400dfdf https://doi.org/10.1016/j.jcin.2020.07.007

Topics

Mitral valve intervention

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Implication

TMVR with adjunctive LAMPOON and pre-emptive ASA shows moderate technical success in high-risk ViMAC/ViRing cases; leaves open the need for dedicated devices and prospective trials.

Contemporary Transcatheter Mitral Valve Replacement for Mitral Annular Calcification or Ring

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Contemporary Transcatheter Mitral Valve Replacement for Mitral Annular Calcification or Ring

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider