Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients With Versus Without Mitral Annular Calcium

Abstract

There are limited data regarding the impact of mitral annular calcium (MAC) on the outcomes of patients who underwent transcatheter aortic valve implantation (TAVI). We performed a retrospective analysis of patients who underwent TAVI in 2018 and divided them into 2 groups based on the presence or absence of MAC, using a validated MAC computed tomography-based scoring system. Among 468 patients who underwent TAVI in 2018, 271 patients (58%) had MAC present compared with 197 patients (42%) without MAC. Compared with patients without MAC, patients in the MAC group were older (81 vs 79, p=0.012), had a higher body mass index (29.30 vs 28.05, p=0.031), lower left ventricular end-diastolic diameter (4.47 vs 4.80, p <0.001), higher mitral valve mean gradient (4.54 vs 3.01, p=0.031), and a higher Society of Thoracic Surgeons risk score (5.69 vs 4.91, p=0.127). There was no significant difference in the with versus without MAC groups in the all-cause mortality (at 1 year: 9% vs 6%, p=0.8; at 2 years: 15% vs 13%, p=0.47), incidence of myocardial infarction (1% vs 2%, p=0.417), stroke (1% vs 3%, p=0.4), and major adverse cardiac and cerebrovascular events (17% vs 19%, p=0.53) at 1 year. Although the rate of new-onset left bundle branch block was higher in patients with MAC, there was no significant difference between the 2 groups in the rates of complete atrioventricular block (5% vs 3%, p=0.483) or the need for pacemaker implantation (6% vs 3%, p=0.168). The post-TAVI peak aortic valve gradient was comparable between the groups with and without MAC (22.52 vs 22.60, p=0.931). In conclusion, TAVI is a safe alternative for patients with severe aortic stenosis and concomitant MAC, with comparable outcomes to patients without MAC.