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Transseptal Transcatheter Mitral Valve Replacement for Mitral Annular Calcification
Mayra GuerreroDavid DanielsBrian WhisenantRaj MakkarPradeep YadavVinod H. ThouraniAmar KrishnaswamyKamran I. MuhammadMichael MorseEvelio RodríguezAdam B. GreenbaumCharanjit S. RihalChristine ChungAlejandro VasquezNicolas M. Van MieghemPaul SorajjaPhilip GideonThom DahleJason FoerstJ. Bradley OldemeyerNeil FamCurtiss StinisMatthew J. PriceOluseun AlliDaniel PuBrian Patrick O’NeillD. MurdochJohn WangPhilipp BlankeMichael PhamFederico M. AschJohn Webb
Key result
Percutaneous transseptal TMVR for MAC-related mitral dysfunction shows uncertain safety and efficacy.
Why the study?
Patients with symptomatic mitral valve dysfunction and mitral annular calcification often have limited treatment options due to advanced age, comorbidities, and unfavorable anatomy, and the role of fully percutaneous transseptal TMVR in this population remains uncertain.
Key Points
- To assess whether fully percutaneous transseptal transcatheter mitral valve replacement provides a viable therapeutic strategy for high-risk patients with mitral valve dysfunction and mitral annular calcification.
- Evaluated clinical barriers in patients with mitral annular calcification and symptomatic mitral valve dysfunction.
- Assessed the anatomical and procedural feasibility of transseptal transcatheter mitral valve replacement relative to conventional surgical replacement and transcatheter repair.
- Extensive annular calcification and significant patient comorbidities frequently preclude standard open-heart surgery and transcatheter repair techniques.
- The role and efficacy of percutaneous transseptal transcatheter valve replacement remain uncertain, presenting an ongoing clinical challenge for managing high-risk structural heart disease.
PICO
P
Population
symptomatic mitral valve dysfunction (MVD) and mitral annular calcification (MAC)
I
Intervention / Comparator
transseptal transcatheter mitral valve replacement (TMVR)
Ask about this paper
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Fully percutaneous transseptal TMVR may offer a viable treatment pathway for select patients with limited therapeutic options. However, successful clinical implementation requires rigorous patient selection, experienced valve centers and careful management of procedural and postprocedural risks. Longer-term follow-up will help define durability, late clinical outcomes and patients most likely to derive meaningful clinical benefit from transseptal TMVR.”
Implication
Transseptal TMVR remains an uncertain option in severe MAC; leaves open its role pending dedicated prospective trials.
Abstract
Patients with symptomatic mitral valve dysfunction (MVD) and mitral annular calcification (MAC) represent one of the most challenging populations in structural heart disease. Advanced age, multiple comorbidities, extensive annular calcification, and unfavorable anatomy often preclude surgical mitral valve replacement or transcatheter repair, leaving many patients with limited treatment options. Whether fully percutaneous transseptal transcatheter mitral valve replacement (TMVR) can provide a meaningful treatment pathway for patients with MAC-related MVD remains uncertain.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
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Cite This Study
Guerrero et al. (2026) studied symptomatic mitral valve dysfunction (MVD) and mitral annular calcification (MAC). transseptal transcatheter mitral valve replacement (TMVR) was evaluated. The efficacy and safety of fully percutaneous transseptal transcatheter mitral valve replacement for patients with MAC-related mitral valve dysfunction remains uncertain.