TAVR: Reasons to Consider Mitral Annular Calcification

Courtesy of Dr. Carlos Fava.

Aortic valve calcification and mitral annular calcification have the same etiology and are frequently present in high-risk patients undergoing transcatheter aortic valve replacement (TAVR). The implications of mitral annular calcification for patients undergoing TAVR has not been entirely clarified yet.

The study examined 782 patients with severe aortic stenosis who underwent TAVR. Among these patients, 375 (49.9%) presented mitral annular calcification in the computerized tomography scan:

• Mild: 30.4%
• Moderate: 9.5%
• Severe: 9.5%

Patients who experienced the highest rate of mitral annular calcification were the eldest (83 vs. 81.9 years old), those with chronic renal insufficiency, and those with a higher Society of Thoracic Surgeons (STS) score (8.8 vs. 7.5; p <0,001).

Procedural success was similar for all patients, and no differences in mortality and major complications were observed at 30 days. At 1 year, severe mitral annular calcification was found to be an independent predictor of all-cause mortality (hazard ratio [HR]: 1.95; 95% confidence interval [CI]: 1.24-3.07; p = 0.004) and cardiovascular mortality (HR: 2.35; 95% CI: 1.19-4.66; p = 0.01). Furthermore, it was an independent predictor of the need for a new permanent pacemaker after TAVR (odds ratio [OR]: 2.83; 95% CI: 1.08-7.47; p = 0.03).

Conclusion

Half of the patients with severe aortic stenosis experience mitral annular calcification. Severe mitral annular calcification is associated with increased all-cause and cardiovascular mortality, and with conduction disorders after TAVR. This pathology should be included in future risk stratification models.

Courtesy of Dr. Carlos Fava. Buenos Aires Favaloro Foundation, Argentina.

Original title: Concomitant Mitral Annular Calcification and Severe Aortic Stenosis: Prevalence, Characteristics and Outcome Following Transcatheter Aortic Valve Replacement.

Reference: Yigal Abramowitz, et al. European Heart Journal Advance Access published December 30, 2016.

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