Mitral Annular Calcification as a Challenging Concomitant Factor for Patients Underwent TAVI

INTRODUCTION: Mitral annular calcification (MAC) is commonly observed in patients with cardiovascular diseases and has been associated with adverse clinical outcomes. This study aims to clarify the prevelance and impact of MAC on peri-procedural, in-hospital, and long-term outcomes in high-surgical-risk patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
METHODS: 403 patients underwent TAVI for severe AS was retrospectively evaluated. MAC was identified on transthoracic-echocardiography and confirmed on computed-tomography in 45.4% of patients. Clinical outcomes, including in-hospital mortality and two-year follow-up mortality, were evaluated, and potential predictors of MAC and mortality were analyzed using logistic and Cox regression models.
RESULTS: MAC was more prevalent in older, female patients with atrial fibrillation. Although the presence of MAC did not correlate with increased in-hospital (unadjOR: 1.77, 95% CI (0.88-3.54), p=0.106) or long-term mortality (unadjOR: 0.73, 95% CI (0.40-1.33), p=0.311), it was associated with a higher requirement for post-TAVI permanent pacemaker implantation (PPI) and moderate-to-severe paravalvular aortic regurgitation (PVAR). Multivariate analysis revealed left ventricular ejection fraction (adjHR: 0.97, 95% CI (0.94-0.99),p=0.015), mean transvalvular gradient, (adjHR: 1.02, 95% CI (1.00-1.04), p=0.0.25) systolic pulmonary artery pressure (adjHR: 1.04, 95% CI (1.01-1.0.6), p=0.001) and severe PVAR (adjHR: 3.16, 95% CI (1.25-7.96), p=0.015) as independent predictors of long-term mortality.
DISCUSSION AND CONCLUSION: In patients with severe AS undergoing TAVI, MAC is a marker of complex cardiac pathology but does not independently predict mortality. However, its presence may increase the need for PPI and the incidence of PVAR, which warrants attention in postoperative management and follow-up.