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Anatomic classification of mitral annular calcification for surgical and transcatheter mitral valve replacement
Author(s) -
Alexis Sophia L.,
Alzahrani Talal S.,
Akkoc Deniz,
Salna Michael,
Khalique Omar K.,
ElEshmawi Ahmed,
Sengupta Aditya,
Hahn Rebecca T.,
Lerakis Stamatios,
Kini Annapoorna,
Sharma Samin K.,
Dangas George D.,
Kodali Susheel K.,
Leon Martin B.,
Adams David H.,
Bapat Vinayak B.,
George Isaac,
Tang Gilbert H. L.
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15535
Subject(s) - medicine , mitral valve replacement , ventricular outflow tract , mitral valve , calcification , ventricular outflow tract obstruction , fibrous joint , cardiology , percutaneous , surgery
Background and Aim of the Study A systematic approach to quantify mitral annular calcification (MAC) in all‐comers by multidetector computed tomography (MDCT) is essential to guide treatment, but lacking. Methods From September 2015 to July 2019, 82 patients with MAC underwent MDCT at two institutions to evaluate for surgical mitral valve replacement (SMVR), transcatheter mitral valve replacement (TMVR), or medical management. Type 1 MAC was defined as <270° annular calcium and Type 2 as ≥270°. Absence/presence of predicted left ventricular outflow tract (LVOT) obstruction with virtual valve placement was used to further define Type 2 MAC into 2A/B for our treatment algorithm. Results Type 1 MAC was present in 51.2%, Type 2A in 18.3%, and Type 2B in 30.5%. Operable Type 1 patients (50.0%) underwent hybrid transatrial TMVR or SMVR. Type 2A underwent a variety of treatments, and Type 2B surgical candidates (40.0%) underwent hybrid transatrial TMVR secondary to difficult suture anchoring with significant MAC and predicted LVOT obstruction. At a follow‐up of 29.6 ± 12.0 months, mortality was 42.7% with 46.3% in the intervention group and 39.0% in the medical group ( p = 0.47). All percutaneous TMVR patients expired. This translated to a disproportionate number of Type 2A deaths (80.0% with intervention), but all were high/extreme surgical risk. The hybrid TMVR group consisted of 95.0% Type 1/2B patients and had a lower Society of Thoracic Surgeons predicted risk of operative mortality (7.4% vs. 9.2%, p = 0.43)/mortality. Conclusions The highest mortality was seen in percutaneous TMVR Type 2A MAC patients, but they were at the greatest risk. Here we provide an objective MAC treatment algorithm for all‐comers based on operability/anatomy.