scholarly journals Impact of mitral annular calcification associated mitral stenosis on clinical outcomes in patients undergoing transcatheter aortic valve implantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Mesnier ◽  
M Urena ◽  
C Nguyen ◽  
J.L Carrasco ◽  
Z Terzian ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ct Scan ◽  
Clinical Outcomes ◽  
Mitral Stenosis ◽  
Pacemaker Implantation ◽  
Mitral Annulus ◽  
Common Finding ◽  
Mitral Annular Calcification ◽  
Valve Implantation ◽  
Annular Calcification

Abstract Introduction Mitral annular calcification (MAC) is a common finding in patient undergoing transaortic valve implantation (TAVI) and can cause significant mitral stenosis (MS). Purpose To assess the impact of MAC associated with significant MS (MAC-MS) on clinical outcomes following TAVR. Methods Consecutive patients undergoing TAVI in our institution between January 2008 and May 2018, were evaluated. All echocardiogram exams before intervention were analysed to identify the presence of MAC and MAC was confirmed on computed tomography (CT) scans. Patients were included in the MAC group if there was any calcification on the mitral annulus on CT scan. Severe MAC was considered as calcification of the mitral annulus involving over 50% of the circumference. Patients with a mitral mechanical valve or bioprosthesis and without CT scan available to confirm MAC were excluded (n=62). MAC-MS was defined as the association of MAC and a mean transmitral gradient over 5 mmHg. Results Among 1177 consecutive finally included patients, 504 (42.8%) had MAC and 85 had a MAC-MS (7.2%, 16.9% among the MAC population). Compared to MAC without MS (MAC non-MS group) and non-MAC patients, patients with MAC-MS were more frequently women (p<0.0001), had a greater BMI (p=0.002), more previous pacemaker implantation (p=0.035), smaller indexed aortic valve area and left ventricular end systolic diameter (p=0.019 and p=0.038). At 30-days after TAVR, there were no differences in stroke, major vascular complication and pacemaker implantation between groups. However, MAC-MS patients had higher rates of tamponade [Odd Ratio adjusted 3.12, 95% confidence interval (CI) 1.08–9.07, p=0.036] and mortality [Adjusted hazard Ratio (HRa) 2.83, 95% CI 1.39–5.76, p<0.005] after adjustment on baseline characteristics. At 1 year, patients with MAC-MS had a higher risk of death [19 (22.1%) vs. 142 (13%); HRa 1.83, 95% CI 1.14–3.03, p=0.01] compared to MAC non-MS and non-MAC patients. Severe MAC was not a predictor of 1 year mortality. Conclusions Mitral stenosis due to mitral annular calcification is infrequent in patient undergoing TAVI but is associated with higher early and mid-term mortality. Funding Acknowledgement Type of funding source: None

scholarly journals Safety and Efficacy of Myval Implantation in Patients with Severe Bicuspid Aortic Valve Stenosis—A Multicenter Real-World Experience

2022 ◽  
Vol 11 (2) ◽  
pp. 443
Author(s):  
Ahmed Elkoumy ◽  
John Jose ◽  
Christian J. Terkelsen ◽  
Henrik Nissen ◽  
Sengottuvelu Gunasekaran ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Clinical Outcomes ◽  
Bicuspid Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Pacemaker Implantation ◽  
Vascular Complications ◽  
Effective Orifice Area ◽  
Transcatheter Heart Valve ◽  
The Mean ◽  
Valve Implantation

Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly and is apparent in nearly 50% of candidates for AV replacement. While transcatheter aortic valve implantation (TAVI) is a recommended treatment for patients with symptomatic severe aortic stenosis (AS) at all surgical risk levels, experience with TAVI in severe bicuspid AS is limited. TAVI in BAV is still a challenge due to its association with multiple and complex anatomical considerations. A retrospective study has been conducted to investigate TAVI’s procedural and 30-day outcomes using the Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd. Vapi, Gujarat, India) in patients with severe bicuspid AS. Data were collected on 68 patients with severe bicuspid AS who underwent TAVI with the Myval THV. Baseline characteristics, procedural, 30-day echocardiographic and clinical outcomes were collected. The mean age and STS PROM score were 72.6 ± 9.4 and 3.54 ± 2.1. Procedures were performed via the transfemoral route in 98.5%. Major vascular complications (1.5%) and life-threatening bleeding (1.5%) occurred infrequently. No patient had coronary obstruction, second valve implantation or conversion to surgery. On 30-day echocardiography, the mean transvalvular gradient and effective orifice area were 9.8 ± 4.5 mmHg and 1.8 ± 0.4 cm2, respectively. None/trace aortic regurgitation occurred in 76.5%, mild AR in 20.5% and moderate AR in 3%. The permanent pacemaker implantation rate was 8.5% and 30-day all-cause death occurred in 3.0% of cases. TAVI with the Myval THV in selected BAV anatomy is associated with favorable short-term hemodynamic and clinical outcomes.

scholarly journals Does isolated mitral annular calcification in the absence of mitral valve disease affect clinical outcomes after transcatheter aortic valve replacement?

2019 ◽  
Vol 21 (5) ◽  
pp. 522-532 ◽  
Author(s):  
Taishi Okuno ◽  
Masahiko Asami ◽  
Faisal Khan ◽  
Fabien Praz ◽  
Dik Heg ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Mitral Valve Disease ◽  
Transcatheter Aortic Valve Replacement ◽  
Mitral Annular Calcification ◽  
Transcatheter Aortic Valve ◽  
Annular Calcification

Abstract Aims  Mitral annular calcification (MAC) has been associated with adverse outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) but has been investigated in isolation of co-existent mitral regurgitation or mitral stenosis, which may represent important confounders. This study sought to investigate the effect of MAC with and without concomitant mitral valve disease (MVD) on clinical outcomes in patients treated with TAVR. Methods and results  Computed tomography (CT) and echocardiographic data in consecutive TAVR patients enrolled into a prospective registry were categorized according to presence or absence of severe MAC and significant MVD, respectively. A total of 967 patients with adequate CT and echocardiography data were included between 2007 and 2017. Severe MAC was found in 172 patients (17.8%) and associated with MVD in 87 patients (50.6%). Compared to TAVR patients without severe MAC or MVD, all-cause mortality at 1 year was significantly increased among patients with severe MAC in combination with MVD [adjusted hazard ratio (HRadj): 1.97, 95% confidence interval (CI): 1.12–3.44, P = 0.018] and patients with isolated MVD (HRadj: 2.33, 95% CI: 1.56–3.47, P < 0.001), but not in patients with isolated severe MAC in the absence of MVD (HRadj: 0.52, 95% CI: 0.21–1.33, P = 0.173). Conclusion  We found no effect of isolated MAC on clinical outcomes following TAVR in patients with preserved mitral valve function. Patients with MVD had an increased risk of death at 1 year irrespective of MAC.

Abstract 16851: Simultaneous Mitral Valve Replacement, Aortic Valve Replacement, Tricuspid Valve Repair, Left Atrial Appendage Ligation, Maze Procedure And Cabg In A 57-year Old Female With History Of Tavr And Severe Mitral Annular Calcification

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Hassan Mehmood Lak ◽  
Joshua Cohen ◽  
Jean Pierre Iskandar ◽  
Mohamed Gad ◽  
Sanchit Chawla ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Tricuspid Regurgitation ◽  
Mitral Stenosis ◽  
Maze Procedure ◽  
Mitral Annular Calcification ◽  
Severe Tricuspid Regurgitation ◽  
History Of ◽  
Annular Calcification

Background: Open heart surgery is preferred for patients with multiple valvular issues with conflicting physiology. Case: A 57-year-old female with a past medical history of Type I Diabetes Mellitus complicated by kidney & pancreatic transplant in 1999 s/p failed kidney transplant in 2016 subsequently back on dialysis, aortic stenosis leading to Transcatheter Aortic Valve Replacement (TAVR) in 2016 who presented to the hospital for profound cardiogenic shock and was found to have severe tricuspid regurgitation, severe mitral stenosis secondary to mitral annular calcification with severe concentric hypertrophy of left ventricle. Decision Making: Her conflicting right and left heart physiology due to Tricuspid Regurgitation and Mitral Stenosis was very difficult to manage medically. She was not deemed a candidate for a heart transplant due to a history of a failed kidney transplant. She underwent surgery which included Mitral Valve Replacement, explant TAVR and repeat aortic valve replacement, Tricuspid repair, Left atrial appendage ligation and maze procedure, and CABG x1 with saphenous vein graft to PDA. She stayed on V-V extracorporeal membrane oxygenation (ECMO) post-operatively and was discharged on post-operative Day # 14. Conclusion: Severe tricuspid Regurgitation & coexisting mitral stenosis pose a dilemma for medical management and only feasible option is surgery which could be extremely challenging.

Minimally Invasive Transaortic Mitral Decalcification during Aortic Valve Replacement

2015 ◽  
Vol 10 (4) ◽  
pp. 288-290 ◽  
Author(s):  
Toshinori Totsugawa ◽  
Taichi Sakaguchi ◽  
Arudo Hiraoka ◽  
Hiroshi Matsushita ◽  
Yuki Hirai ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Mitral Annular Calcification ◽  
Transcatheter Aortic Valve ◽  
Double Valve Replacement ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Annular Calcification

Mitral annular calcification accompanied by aortic stenosis is hazardous for both double-valve replacement and transcatheter aortic valve implantation. Less invasive mitral procedure is required in this condition, and minimally invasive approach may further reduce the operative risk in high-risk patients. Here, we report minimally invasive transaortic mitral decalcification during aortic valve replacement through minithoracotomy. We believe that this option is feasible in patients who are at prohibitive risk for double-valve replacement or transcatheter aortic valve implantation because of severe mitral annular calcification.

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