Contemporary experience of mitral transcatheter edge‐to‐edge repair technology in patients with mitral annular calcification

Abstract Background Mitral annular calcification (MAC) has been an exclusion for many of the earlier pivotal trials that were instrumental in gaining device approval and indications for mitral transcatheter edge‐to‐edge repair (M‐TEER). Aims To evaluate the impact of MAC on the procedural durability and success of newer generation MitraClip® systems (G3 and G4 systems). Methods Data were collected from Northwell TEER registry. Patients that underwent M‐TEER with third or fourth generation MitraClip device were included. Patients were divided into −MAC (none‐mild) and +MAC (moderate‐severe) groups. Procedural success was defined as ≤ grade 2 + mitral regurgitation (MR) postprocedure, and durability was defined as ≤ grade 2 + MR retention at 1 month and 1 year. Univariate analysis compared outcomes between groups. Results Of 260 M‐TEER patients, 160 were −MAC and 100 were +MAC. Procedural success was comparable; however, there were three patients who required conversion to cardiac surgery during the index hospitalization in the +MAC group versus none in the −MAC group (though this was not statistically significant). At 1‐month follow‐up, there were no significant differences in MR severity. At 1‐year follow‐up, +MAC had higher moderate‐severe MR (22.1% vs. 7.5%; p = 0.002) and higher mean transmitral gradients (5.3 vs. 4.0 mmHg; p = 0.001) with no differences in mortality, New York Heart Association functional class or ejection fraction. Conclusion In selective patients with high burden of MAC, contemporary M‐TEER is safe, and procedural success is similar to patients with none‐mild MAC. However, a loss of procedural durability was seen in +MAC group at 1‐year follow‐up. Further studies with longer follow‐ups are required to assess newer mTEER devices and their potential clinical implications in patients with a high burden of MAC.