TY - JOUR
T1 - Outcomes Following Transcatheter Mitral Valve Replacement Using Dedicated Devices in Patients With Mitral Annular Calcification
AU - CHOICE-MI Investigators
AU - Coisne, Augustin
AU - Ludwig, Sebastian
AU - Scotti, Andrea
AU - Ben Ali, Walid
AU - Weimann, Jessica
AU - Duncan, Alison
AU - Webb, John G.
AU - Kalbacher, Daniel
AU - Rudolph, Tanja K.
AU - Nickenig, Georg
AU - Hausleiter, Jörg
AU - Ruge, Hendrik
AU - Adam, Matti
AU - Petronio, Anna S.
AU - Dumonteil, Nicolas
AU - Søndergaard, Lars
AU - Adamo, Marianna
AU - Regazzoli, Damiano
AU - Garatti, Andrea
AU - Schmidt, Tobias
AU - Dahle, Gry
AU - Taramasso, Maurizio
AU - Walther, Thomas
AU - Kempfert, Joerg
AU - Obadia, Jean François
AU - Redwood, Simon
AU - Tang, Gilbert H.L.
AU - Goel, Sachin
AU - Fam, Neil
AU - Metra, Marco
AU - Andreas, Martin
AU - Muller, David W.
AU - Denti, Paolo
AU - Praz, Fabien
AU - von Bardeleben, Ralph Stephan
AU - Leroux, Lionel
AU - Latib, Azeem
AU - Granada, Juan F.
AU - Conradi, Lenard
AU - Modine, Thomas
N1 - Publisher Copyright:
© 2024 American College of Cardiology Foundation
PY - 2024/9/23
Y1 - 2024/9/23
N2 - 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.
AB - 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.
KW - mitral annular calcification
KW - transcatheter mitral valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85203618870&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2024.07.038
DO - 10.1016/j.jcin.2024.07.038
M3 - Article
C2 - 39243262
AN - SCOPUS:85203618870
SN - 1936-8798
VL - 17
SP - 2141
EP - 2153
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 18
ER -