Mitral annular calcification: the evolving role of hybrid mitral valve replacement

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Severe mitral annular calcification (MAC). Intervention: Hybrid transatrial transcatheter mitral valve replacement (TMVR) vs. Conventional surgery or fully percutaneous therapy.

Beatrice Bacchi; Francesco Cabrucci

doi:10.21037/jovs-2026-0030

September 1, 2026Journal of Visualized SurgeryOpen Access

Mitral annular calcification: the evolving role of hybrid mitral valve replacement

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Key result

Hybrid transatrial transcatheter mitral valve replacement is an evolving alternative for severe mitral annular calcification that mitigates some procedural challenges but remains technically demanding with significant early mortality risk.

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Key Points

To review the evolving role, procedural techniques, and clinical outcomes of hybrid transatrial transcatheter mitral valve replacement in patients with severe mitral annular calcification.
Evaluation of hybrid surgical-transcatheter approaches utilizing direct transatrial access, anterior leaflet resection, and balloon-expandable valves with customized pericardial skirts.
Synthesis of clinical outcomes from the TMVR in MAC Global Registry (N=116 extreme-risk patients) and a multicenter hybrid transatrial cohort (N=126 patients).
In the multicenter hybrid cohort of 126 patients, technical success reached 94.4%, LVOT obstruction occurred in 6.3%, greater-than-mild paravalvular leak in 4.2%, and 30-day mortality was 12.7% (16 patients) with 33 deaths by 1 year.
In the TMVR in MAC Global Registry (N=116), 30-day and 1-year all-cause mortality were 25.0% and 53.7%, stroke rates were 4.3% and 6.6%, and valve reinterventions occurred in 7.7% and 12.3%, respectively.
Among early survivors in the global registry, 71.8% achieved New York Heart Association functional class I or II symptoms at 1 year, while prosthetic valve thrombosis occurred in 1.8%.

Structured PICO

P

Population

Patients with severe mitral annular calcification (MAC) requiring mitral valve replacement

I

Intervention

Hybrid transatrial transcatheter mitral valve replacement (TMVR)

Limitations

Evidence is limited to small retrospective series and single-center experiences with relatively short follow-up.
Lack of long-term data regarding comparative effectiveness, structural durability, and thrombosis.
The technique is highly center-dependent and may not be broadly reproducible in lower-volume institutions.
Represents an off-label use of balloon-expandable transcatheter aortic valve prostheses.
Lack of long-term data on durability, thrombosis, and tissue degeneration
Current evidence limited to small retrospective series and single-center experiences with short follow-up
Favorable results reflect highly specialized center experience and may not be reproducible in lower-volume institutions

Implication

Hybrid transatrial TMVR provides a promising intermediate treatment strategy for severe MAC in carefully selected patients, though it remains a technically demanding, off-label procedure requiring multidisciplinary Heart Team expertise.

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Cite This Study

Bacchi et al. (2026) conducted an editorial in Severe mitral annular calcification (MAC). Hybrid transatrial transcatheter mitral valve replacement (TMVR) vs. Conventional surgery or fully percutaneous therapy was evaluated. Hybrid transatrial transcatheter mitral valve replacement is an evolving alternative for severe mitral annular calcification that mitigates some procedural challenges but remains technically demanding with significant early mortality risk.

synapsesocial.com/papers/6ad1159000741cc3fba7d5fe https://doi.org/10.21037/jovs-2026-0030

View Full Paper

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Mitral annular calcification: the evolving role of hybrid mitral valve replacement

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Mitral annular calcification: the evolving role of hybrid mitral valve replacement

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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