Augustin Coisne MD, PhD , Sebastian Ludwig MD , Andrea Scotti MD , Walid Ben Ali MD, PhD , Jessica Weimann MSc , Alison Duncan MD , John G. Webb MD , Daniel Kalbacher MD , Tanja K. Rudolph MD , Georg Nickenig MD , Jörg Hausleiter MD , Hendrik Ruge MD , Matti Adam MD , Anna S. Petronio MD , Nicolas Dumonteil MD , Lars Søndergaard MD , Marianna Adamo MD , Damiano Regazzoli MD , Andrea Garatti MD , Tobias Schmidt MD , Thomas Modine MD, PhD
{"title":"Outcomes Following Transcatheter Mitral Valve Replacement Using Dedicated Devices in Patients With Mitral Annular Calcification","authors":"Augustin Coisne MD, PhD , Sebastian Ludwig MD , Andrea Scotti MD , Walid Ben Ali MD, PhD , Jessica Weimann MSc , Alison Duncan MD , John G. Webb MD , Daniel Kalbacher MD , Tanja K. Rudolph MD , Georg Nickenig MD , Jörg Hausleiter MD , Hendrik Ruge MD , Matti Adam MD , Anna S. Petronio MD , Nicolas Dumonteil MD , Lars Søndergaard MD , Marianna Adamo MD , Damiano Regazzoli MD , Andrea Garatti MD , Tobias Schmidt MD , Thomas Modine MD, PhD","doi":"10.1016/j.jcin.2024.07.038","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Patients with mitral regurgitation (MR) and morphologic presence of relevant mitral annular calcification (MAC) represent a challenging phenotypic subset with limited treatment options.</div></div><div><h3>Objectives</h3><div>The aim of this study was to assess the feasibility of transcatheter mitral valve replacement (TMVR) using dedicated devices for the treatment of MAC patients.</div></div><div><h3>Methods</h3><div>Consecutive patients with symptomatic MR receiving TMVR and with available computed tomography data from the CHOICE-MI (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) multicenter registry were stratified by the presence of none or mild mitral annular calcification (MAC<sub>none/mild</sub>) vs moderate or severe mitral annular calcification (MAC<sub>mod/sev</sub>).</div></div><div><h3>Results</h3><div>Among 279 eligible patients (median age = 76.0 years [Q1-Q3: 71.0-81.0 years], EuroSCORE II = 6.2% [Q1-Q3: 3.9%-12.1%]), 222 (79.6%) presented with MAC<sub>none/mild</sub> and 57 (20.4%) with MAC<sub>mod/sev</sub>. Patients with MAC<sub>mod/sev</sub> had a higher prevalence of extracardiac arteriopathy (<em>P =</em> 0.011) and primary MR (<em>P <</em> 0.001). Although the technical success rate and the extent of MR elimination did not differ, TMVR treatment in MAC<sub>mod/sev</sub> patients was associated with higher rates of postprocedural bleeding complications (<em>P =</em> 0.02) and renal failure (<em>P <</em> 0.001). Functional improvement at the 1- and 2-year follow-up did not differ between groups. At the 2-year follow-up, there were no differences between patients with MAC<sub>mod/sev</sub> and MAC<sub>none/mild</sub> regarding all-cause mortality (38.5% vs 37.7%; <em>P =</em> 0.76), cardiovascular mortality (21.3% vs 24.9%; <em>P =</em> 0.97), and all-cause mortality or heart failure hospitalization (52.4% vs 46.7%; <em>P =</em> 0.28)</div></div><div><h3>Conclusions</h3><div>TMVR in patients with MAC<sub>mod/sev</sub> is associated with higher rates of postprocedural complications but similar rates of survival, MR resolution, and functional improvement compared to MAC<sub>none/mild</sub>. Further studies are necessary to define the role of dedicated TMVR devices in this population. (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency Registry [CHOICE-MI]; <span><span>NCT04688190</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 18","pages":"Pages 2141-2153"},"PeriodicalIF":11.7000,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Cardiovascular interventions","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1936879824010355","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Patients with mitral regurgitation (MR) and morphologic presence of relevant mitral annular calcification (MAC) represent a challenging phenotypic subset with limited treatment options.
Objectives
The aim of this study was to assess the feasibility of transcatheter mitral valve replacement (TMVR) using dedicated devices for the treatment of MAC patients.
Methods
Consecutive patients with symptomatic MR receiving TMVR and with available computed tomography data from the CHOICE-MI (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) multicenter registry were stratified by the presence of none or mild mitral annular calcification (MACnone/mild) vs moderate or severe mitral annular calcification (MACmod/sev).
Results
Among 279 eligible patients (median age = 76.0 years [Q1-Q3: 71.0-81.0 years], EuroSCORE II = 6.2% [Q1-Q3: 3.9%-12.1%]), 222 (79.6%) presented with MACnone/mild and 57 (20.4%) with MACmod/sev. Patients with MACmod/sev had a higher prevalence of extracardiac arteriopathy (P = 0.011) and primary MR (P < 0.001). Although the technical success rate and the extent of MR elimination did not differ, TMVR treatment in MACmod/sev patients was associated with higher rates of postprocedural bleeding complications (P = 0.02) and renal failure (P < 0.001). Functional improvement at the 1- and 2-year follow-up did not differ between groups. At the 2-year follow-up, there were no differences between patients with MACmod/sev and MACnone/mild regarding all-cause mortality (38.5% vs 37.7%; P = 0.76), cardiovascular mortality (21.3% vs 24.9%; P = 0.97), and all-cause mortality or heart failure hospitalization (52.4% vs 46.7%; P = 0.28)
Conclusions
TMVR in patients with MACmod/sev is associated with higher rates of postprocedural complications but similar rates of survival, MR resolution, and functional improvement compared to MACnone/mild. Further studies are necessary to define the role of dedicated TMVR devices in this population. (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency Registry [CHOICE-MI]; NCT04688190)
期刊介绍：
JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.
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