TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis

Schaefer, Andreas; Sarwari, Harun; Schofer, Niklas; Schneeberger, Y.; Westermann, Dirk; Schoen, Gerhard; Blankenberg, Stefan; Reichenspurner, Hermann; Schäfer, Ulrich; Conradi, Lenard

doi:10.1055/s-0039-1700966

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…This chronic disease is found in 10% of patients over the age 60 and 33% of those over 90 years ( 2 ), thus patients are often at very high risk for surgery. In recent years, there has accordingly been interest in the transcatheter deployment of valves inside the MAC to treat significant mitral regurgitation or stenosis ( 3 , 4 ). Despite the promise of this non-surgical technique, this procedure is still associated with a 1-year outcome of all-cause mortality reported as 34.5% ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification

Hill

Young

Prendergast

et al. 2022

Front. Cardiovasc. Med.

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IntroductionTranscatheter mitral valve replacement is a promising alternative to open-heart surgery in elderly patients. Patients with severe mitral annulus calcification (MAC) are a particularly high-risk population, where postprocedural complications can have catastrophic effects. Amongst these, obstruction of the left ventricular outflow tract can lead to ventricular hypertrophic remodeling and subsequent heart failure, while subclinical valve thrombosis can result in early bioprosthetic valve failure.MethodsTo elucidate the mechanisms of left ventricular outflow tract obstruction and valve thrombosis following valve-in-MAC procedures, we used image processing and Computational Fluid Dynamics (CFD) software to generate patient- and device-specific models based on preprocedural CT data. Personalized computer simulations were performed to predict the left ventricular haemodynamics after implantation in three patients with severe MAC.ResultsThe simulations have successfully captured the increased pressure gradient in the left ventricular outflow tract as a result of the partial obstruction due to the implanted valve. Regions of wall shear stress above the threshold value for platelet activation were also observed on the bioprosthetic frame as a result of the reduced outflow tract area, which led to increases in flow resistance and blood residence time inside the ventricle. Consistent with these findings, areas of slow recirculating flow and blood stasis formed near the valve frame, creating potential pro-thrombotic conditions.DiscussionThis study provides insight into the relationship between size and shape of the outflow tract post-implantation, pressure gradients and pro-thrombotic flow metrics such as wall shear stress and blood residence time. Results show the potential of CFD modeling to bring key functional metrics into preprocedural assessment for a comprehensive evaluation of post-procedural risks beyond anatomical factors. Following further validation and extension to the atrial chamber, this approach can provide an in-depth analysis of the likelihood of valvular thrombosis.

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Section: Introductionmentioning

confidence: 99%

Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification

Hill

Young

Prendergast

et al. 2022

Front. Cardiovasc. Med.

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“…However, in agreement with Okuno et al [47], the sole presence of MAC, even in its severe form, did not significantly increase all-cause mortality during the 30-day and 1-year follow-up periods. In contrast, several studies reported that the presence of MAC-related MVD was associated with higher mortality rates at both the 30-day and 1-year marks [46][47][48][49][50][51][52][53].…”

Section: Mac and Aortic Stenosismentioning

confidence: 89%

Mitral Annular Calcification-Related Valvular Disease: A Challenging Entity

Museedi,

Le Jemtel

2024

JCM

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Mitral valve annular calcification-related valvular disease is increasingly common due to the rising prevalence of age-related mitral annular calcifications. Mitral annular calcification alters the structure and function of the mitral valve annulus, which in turn causes mitral valve regurgitation, stenosis, or both. As it frequently coexists with comorbid conditions and overlapping symptoms, mitral annular calcification-related valvular disease poses significant diagnostic and therapeutic challenges. For instance, left ventricular diastolic dysfunction hinders the assessment of mitral valvular disease. Detection of mitral annular calcifications and assessment of related mitral valve disease hinge on two-dimensional echocardiography. Comprehensive assessment of mitral annular calcifications and related mitral valve disease may require multidetector computed tomography and three-dimensional echocardiography. Invasive hemodynamic testing with exercise helps identify the cause of symptoms in patients with comorbid conditions, and transcatheter interventions have emerged as a viable therapeutic option for older patients. After an outline of the normal mitral annulus, we examine how mitral annular calcifications lead to mitral valve disease and how to accurately assess mitral regurgitation and stenosis. Lastly, we review surgical and transcatheter approaches to the management of mitral annular calcification-related mitral valve regurgitation, stenosis, or both.

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“…There is also growing interest around MAC, partly related to its clinical impact in transcatheter therapies. 26 Beside the higher prevalence and more severe burden of MAC found in women, data on risk factors leading to the development of MAC remain scarce. Hypertension, diabetes and hypercholesterolaemia have been previously associated with MAC.…”

Section: Valvular Heart Diseasementioning

confidence: 99%

Sex-specific correlates of valvular and arterial calcification burden in patients with moderate aortic stenosis

et al. 2022

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IntroductionThere are significant sex differences in the prevalence and severity of cardiac calcifying processes. Women harbour more severe mitral annular calcification (MAC), while men exhibit worse aortic valve (AVC) and coronary artery (CAC) calcification. To better understand these differences, we investigated the correlates of cardiac calcification according to sex.MethodsWe conducted a cross-sectional study of 406 patients with ≥mild aortic stenosis (AS) defined by an aortic valve area ≤1.5 cm2, a peak aortic jet velocity >2.0 m/s, or a mean transvalvular gradient >15 mm Hg. Doppler-echocardiography and non-contrast multidetector CT were performed concomitantly to assess AS and cardiac calcifications.ResultsMean age was 71±11 years and 33% were women. The AS haemodynamics were not significantly different between sexes (all p>0.50), with a mean indexed aortic valve area of 0.59±0.21 cm2/m2, peak aortic jet velocity of 2.78 (2.37–3.68) m/s, and mean gradient of 17.9 (12.8–31.3) mm Hg for the whole cohort. Compared with men, women harboured lower AVC (480 (222–1191) vs 1003 (484–2329) Agatston unit, AU; p<0.0001) and CAC (366 (50–914) vs 618 (167–1357) AU; p=0.007), but more severe MAC (60 (1–887) vs 48 (0–351) AU; p=0.08) and ascending aorta calcification (227 (43–863) vs 142 (7–493) AU; p=0.03). After comprehensive adjustment, sex remained an independent predictor of each cardiac calcification subtype (all p<0.02) except for the ascending aorta (p=0.32). In multivariable analysis, certain variables, like age or bicuspid aortic valve, were associated with the calcification scores in both sexes. Sex-specific predictors of calcification burden were absence of angiotensin receptor blockers (β=−0.26; p=0.007) and renal impairment (β=0.26; p=0.003) for AVC, and bisphosphonates (β=0.20; p=0.05) for CAC in women; coronary artery disease (β=0.25; p=0.001) for AVC, and angiotensin receptor blockers (β=0.19; p=0.02) and calcium/vitamin D (β=0.15; p=0.02) for MAC in men.ConclusionIn AS, factors associated with cardiac valvular and arterial calcification differ between sexes, suggesting an important contributory role of sex in the pathophysiology of these calcifying processes.

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TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis

Cited by 5 publications

References 30 publications

Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification

Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification

Mitral Annular Calcification-Related Valvular Disease: A Challenging Entity

Sex-specific correlates of valvular and arterial calcification burden in patients with moderate aortic stenosis

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