Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular Calcification: A Systematic Review

Abstract

Mitral annular calcification with mitral valve disease is a challenging problem that could necessitate surgical mitral valve replacement (SMVR). Transcatheter mitral valve replacement (TMVR) is emerging as a feasible alternative in high‐risk patients with appropriate anatomy. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to December 25, 2019 for studies discussing SMVR or TMVR in patients with mitral annular calcification; 27 of 1539 articles were selected for final review. TMVR was used in 15 studies. Relevant data were available on 82 patients who underwent hybrid transatrial TMVR, and 354 patients who underwent transapical or transseptal TMVR. Outcomes on SMVR were generally reported as small case series (447 patients from 11 studies); however, 1 large study recently reported outcomes in 9551 patients. Patients who underwent TMVR had a shorter median follow‐up of 9 to 12 months (range, in‐hospital‒19 months) compared with patients with SMVR (54 months; range, in‐hospital‒120 months). Overall, those undergoing TMVR were older and had higher Society of Thoracic Surgeons risk scores. SMVR showed a wide range of early (0%–27%; median 6.3%) and long‐term mortality (0%–65%; median at 1 year, 15.8%; 5 years, 38.8%, 10 years, 62.4%). The median in‐hospital, 30‐day, and 1‐year mortality rates were 16.7%, 22.7%, and 43%, respectively, for transseptal/transapical TMVR, and 9.5%, 20.0%, and 40%, respectively, for transatrial TMVR. Mitral annular calcification is a complex disease and TMVR, with a versatile option of transatrial approach in patients with challenging anatomy, offers a promising alternative to SMVR in high‐risk patients. However, further studies are needed to improve technology, patient selection, operative expertise, and long‐term outcomes.

Mitral annular calcification in patients with significant mitral valve disease: An old problem with new solutions

“…This unsatisfactory survival results were confirmed also by a prospective trial (MITRAL), that showed an in-hospital, 30-days, and 1-year mortality of 9.5, 20.0, and 40%, respectively ( 13 ).…”

“…Different types of transcatheter aortic valves were used, even if most of the patients received SapienXT prosthesis or Sapien3 (Edwards Lifesciences, Irvine, CA, USA) ( 13 ). Before valve delivery, anterior mitral leaflet is usually resected and thus transatrial access offers a very low risk of left ventricular outflow tract obstruction (LVOTO).…”

“…Most of the available reports about these approaches are retrospective and include a small cohort of patients. The most used valves were SapienXT prosthesis or Sapien3 (Edwards Lifesciences, Irvine, CA, USA) ( 13 ).…”

Successful mitral valve-in-ring repair of mitral annuloplasty ring dehiscence causing severe mitral regurgitation: a case report

“…We propose that the mechanism by which improvement of the para-ring MR occurred is by the expanded circular THV pushing the D-shaped semirigid ring at the posterior site, thus improving contact between the ring and the posterior annular tissue ( Figure 5 ). 15 The observed improvement in para-ring regurgitation may not be extended to rigid complete rings (e.g. Edwards IMR ETlogix or St Jude Saddle annuloplasty rings) as contact between the ring and annular tissue may not be altered.…”

Design Variation, Implantation, and Outcome of Transcatheter Mitral Valve Prosthesis: A Comprehensive Review

“…Following the promising developments in TAVR devices, some of the earliest and common TMVI procedures were done using TAVR devices (e.g., Sapien M3, Sapien XT) via valve-in-valve (VIV) approach in degenerated bioprostheses or severe MAC patients ( 63 – 66 ). This is especially since redo surgery for the degenerated bioprosthetic mitral valve in elderly patients with impaired left ventricular dysfunction and previous cardiac surgery is not ideal ( 67 ).…”