University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France; Cardiovascular Research Foundation, New York, New York, USA.
Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
JACC Cardiovasc Interv. 2024 Sep 23;17(18):2141-2153. doi: 10.1016/j.jcin.2024.07.038. Epub 2024 Sep 4.
Patients with mitral regurgitation (MR) and morphologic presence of relevant mitral annular calcification (MAC) represent a challenging phenotypic subset with limited treatment options.
The aim of this study was to assess the feasibility of transcatheter mitral valve replacement (TMVR) using dedicated devices for the treatment of MAC patients.
Consecutive patients with symptomatic MR receiving TMVR and with available computed tomography data from the CHOICE-MI (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) multicenter registry were stratified by the presence of none or mild mitral annular calcification (MAC) vs moderate or severe mitral annular calcification (MAC).
Among 279 eligible patients (median age = 76.0 years [Q1-Q3: 71.0-81.0 years], EuroSCORE II = 6.2% [Q1-Q3: 3.9%-12.1%]), 222 (79.6%) presented with MAC and 57 (20.4%) with MAC. Patients with MAC had a higher prevalence of extracardiac arteriopathy (P = 0.011) and primary MR (P < 0.001). Although the technical success rate and the extent of MR elimination did not differ, TMVR treatment in MAC patients was associated with higher rates of postprocedural bleeding complications (P = 0.02) and renal failure (P < 0.001). Functional improvement at the 1- and 2-year follow-up did not differ between groups. At the 2-year follow-up, there were no differences between patients with MAC and MAC regarding all-cause mortality (38.5% vs 37.7%; P = 0.76), cardiovascular mortality (21.3% vs 24.9%; P = 0.97), and all-cause mortality or heart failure hospitalization (52.4% vs 46.7%; P = 0.28) CONCLUSIONS: TMVR in patients with MAC is associated with higher rates of postprocedural complications but similar rates of survival, MR resolution, and functional improvement compared to MAC. Further studies are necessary to define the role of dedicated TMVR devices in this population. (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency Registry [CHOICE-MI]; NCT04688190).
患有二尖瓣反流（MR）且存在相关二尖瓣环钙化（MAC）形态的患者是一种具有挑战性的表型亚组，其治疗选择有限。
本研究旨在评估使用专用设备治疗 MAC 患者进行经导管二尖瓣置换术（TMVR）的可行性。
连续接受 TMVR 治疗且 CHOICE-MI（二尖瓣关闭不全的最佳经导管治疗选择）多中心注册中心有可用计算机断层扫描数据的症状性 MR 患者，根据无或轻度二尖瓣环钙化（MAC）与中度或重度二尖瓣环钙化（MAC）进行分层。
在 279 名符合条件的患者（中位年龄 76.0 岁[四分位距 71.0-81.0 岁]，EuroSCORE II 6.2%[四分位距 3.9%-12.1%]）中，222 名（79.6%）患者存在 MAC，57 名（20.4%）患者存在 MAC。MAC 患者的心脏外血管病患病率更高（P = 0.011），原发性 MR 发生率更高（P < 0.001）。尽管技术成功率和 MR 消除程度没有差异，但 MAC 患者的 TMVR 治疗与更高的术后出血并发症发生率（P = 0.02）和肾功能衰竭发生率（P < 0.001）相关。两组在 1 年和 2 年随访时的功能改善没有差异。在 2 年随访时，MAC 和 MAC 患者的全因死亡率（38.5% vs 37.7%；P = 0.76）、心血管死亡率（21.3% vs 24.9%；P = 0.97）和全因死亡率或心力衰竭住院率（52.4% vs 46.7%；P = 0.28）没有差异。
与 MAC 相比，MAC 患者的 TMVR 术后并发症发生率更高，但生存率、MR 缓解率和功能改善率相似。需要进一步的研究来确定专用 TMVR 设备在这一人群中的作用。（二尖瓣关闭不全的最佳经导管治疗选择登记研究[CHOICE-MI]；NCT04688190）。
