Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification
Background The clinical significance of mitral annular calcification (MAC) in patients undergoing mitral transcatheter edge‐to‐edge repair is not well understood. There is limited evidence regarding the feasibility, durability of repair, and the prognostic value of MAC in this population. We sought...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031118 |
| _version_ | 1827580731266695168 |
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| author | Taha Hatab Rody G. Bou Chaaya Syed Zaid Priscilla Wessly Priyanka Satish Victoria Villanueva Nadeen Faza Stephen H. Little Marvin D. Atkins Michael J. Reardon Neal S. Kleiman William A. Zoghbi Sachin S. Goel |
| author_facet | Taha Hatab Rody G. Bou Chaaya Syed Zaid Priscilla Wessly Priyanka Satish Victoria Villanueva Nadeen Faza Stephen H. Little Marvin D. Atkins Michael J. Reardon Neal S. Kleiman William A. Zoghbi Sachin S. Goel |
| author_sort | Taha Hatab |
| collection | DOAJ |
| description | Background The clinical significance of mitral annular calcification (MAC) in patients undergoing mitral transcatheter edge‐to‐edge repair is not well understood. There is limited evidence regarding the feasibility, durability of repair, and the prognostic value of MAC in this population. We sought to examine the prognostic value of MAC, its severity, and its impact on procedural success and durability of mitral transcatheter edge‐to‐edge repair. Methods and Results We reviewed the records of 280 patients with moderate–severe or severe mitral regurgitation who underwent mitral transcatheter edge‐to‐edge repair with MitraClip from March 2014 to March 2022. The primary end point was cumulative survival at 1 year. Independent factors associated with the primary end point were identified using multivariable Cox regression. Among 280 patients included in the final analysis, 249 had none/mild MAC, and 31 had moderate/severe MAC. Median follow‐up was 23.1 months (interquartile range: 11.1–40.4). Procedural success was comparable in the MAC and non‐MAC groups (92.6% versus 91.4%, P=0.79) with similar rates of residual mitral regurgitation ≤2 at 1 year (86.7% versus 93.2%, P=0.55). Moderate/severe MAC was associated with less improvement in New York Heart Association III/IV at 30 days when compared with none/mild MAC (45.8% versus 14.3%, P=0.001). The moderate/severe MAC group had lower cumulative 1‐year survival (56.8% versus 80.0%, hazard ratio [HR], 1.98 [95% CI, 1.27–3.10], P=0.002). Moderate/severe MAC and Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair were independently associated with the primary end point (HR, 2.20 [1.10–4.41], P=0.02; and HR, 1.014 [1.006–1.078], P=0.02, respectively). Conclusions Mitral TEER is a safe and feasible intervention in selected patients with significant MAC and associated with similar mitral regurgitation reduction at 1 year compared with patients with none/mild MAC. Patients with moderate/severe MAC had a high 1‐year mortality and less improvement in their symptoms after TEER. |
| first_indexed | 2024-03-08T22:23:25Z |
| format | Article |
| id | doaj.art-5e7f862e15974a9187b68f24a6c7cd48 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-08T22:23:25Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-5e7f862e15974a9187b68f24a6c7cd482023-12-18T11:20:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-10-01121910.1161/JAHA.123.031118Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular CalcificationTaha Hatab0Rody G. Bou Chaaya1Syed Zaid2Priscilla Wessly3Priyanka Satish4Victoria Villanueva5Nadeen Faza6Stephen H. Little7Marvin D. Atkins8Michael J. Reardon9Neal S. Kleiman10William A. Zoghbi11Sachin S. Goel12Houston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXDepartment of Cardiovascular Surgery Houston Methodist Hospital Houston TXDepartment of Cardiovascular Surgery Houston Methodist Hospital Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXBackground The clinical significance of mitral annular calcification (MAC) in patients undergoing mitral transcatheter edge‐to‐edge repair is not well understood. There is limited evidence regarding the feasibility, durability of repair, and the prognostic value of MAC in this population. We sought to examine the prognostic value of MAC, its severity, and its impact on procedural success and durability of mitral transcatheter edge‐to‐edge repair. Methods and Results We reviewed the records of 280 patients with moderate–severe or severe mitral regurgitation who underwent mitral transcatheter edge‐to‐edge repair with MitraClip from March 2014 to March 2022. The primary end point was cumulative survival at 1 year. Independent factors associated with the primary end point were identified using multivariable Cox regression. Among 280 patients included in the final analysis, 249 had none/mild MAC, and 31 had moderate/severe MAC. Median follow‐up was 23.1 months (interquartile range: 11.1–40.4). Procedural success was comparable in the MAC and non‐MAC groups (92.6% versus 91.4%, P=0.79) with similar rates of residual mitral regurgitation ≤2 at 1 year (86.7% versus 93.2%, P=0.55). Moderate/severe MAC was associated with less improvement in New York Heart Association III/IV at 30 days when compared with none/mild MAC (45.8% versus 14.3%, P=0.001). The moderate/severe MAC group had lower cumulative 1‐year survival (56.8% versus 80.0%, hazard ratio [HR], 1.98 [95% CI, 1.27–3.10], P=0.002). Moderate/severe MAC and Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair were independently associated with the primary end point (HR, 2.20 [1.10–4.41], P=0.02; and HR, 1.014 [1.006–1.078], P=0.02, respectively). Conclusions Mitral TEER is a safe and feasible intervention in selected patients with significant MAC and associated with similar mitral regurgitation reduction at 1 year compared with patients with none/mild MAC. Patients with moderate/severe MAC had a high 1‐year mortality and less improvement in their symptoms after TEER.https://www.ahajournals.org/doi/10.1161/JAHA.123.031118mitral annular calcificationmitral regurgitationTEER |
| spellingShingle | Taha Hatab Rody G. Bou Chaaya Syed Zaid Priscilla Wessly Priyanka Satish Victoria Villanueva Nadeen Faza Stephen H. Little Marvin D. Atkins Michael J. Reardon Neal S. Kleiman William A. Zoghbi Sachin S. Goel Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease mitral annular calcification mitral regurgitation TEER |
| title | Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification |
| title_full | Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification |
| title_fullStr | Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification |
| title_full_unstemmed | Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification |
| title_short | Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification |
| title_sort | feasibility and outcomes of mitral transcatheter edge to edge repair in patients with variable degrees of mitral annular calcification |
| topic | mitral annular calcification mitral regurgitation TEER |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031118 |
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