Outcomes of Mitral Transcatheter Edge-to-Edge Repair in Patients with Mitral Annular Calcification
Presenter
Karim Al-Azizi, MD, FSCAI, Baylor Scott & White The Heart Hospital - Plano, Plano, TX
Karim Al-Azizi, MD, FSCAI1, Mathew Rulon Williams, M.D.2, Paul Dennis Mahoney, M.D., FSCAI3, Matthew J. Price, MD4, Mirjam Kessler, MD5, Mustafa I. Ahmed, M.D.6, Helge Moellmann, MD7, Bassem M. Chehab, M.D., FSCAI8, Jason H. Rogers, M.D., FSCAI9, Frederico Asch, M.D.10, Jose Zamorano, M.D.11, Ralph Matar, MD12, Melody Dong, PhD13, Rong Huang13, Evelio Rodriguez, M.D.14, Ralph Stephan von Bardeleben, MD15, Francesco Maisano, M.D.16 and Saibal Kar, M.D., FSCAI17, (1)Baylor Scott & White The Heart Hospital - Plano, Plano, TX, (2)NYU Langone Health, New York, NY, (3)ECU Health Medical Center, Greenville, NC, (4)Scripps Clinic Medical Group, La Jolla, CA, (5)Ulm University Heart Center, University of Ulm, Ulm, Ulm, Germany, (6)University of Alabama at Birmingham Medicine, Birmingham, AL, (7)St. Johannes Hospital, Dortmund, Dortmund, Germany, (8)Ascension Via Christi Health, Wichita, KS, (9)UC Davis Medical Center, Sacramento, CA, (10)MedStar, Washington, DC, (11)Hospital Ramon y Cajal, Madrid, Madrid, Spain, (12)Baylor Scott & White The Heart Hospital - Plano, Richardson, TX, (13)Abbott, Santa Clara, CA, (14)St. Thomas Heart Hospital, Nashville, TN, (15)Institut de Cardiologie de Montréal (MHI), Montreal, QC, Canada, (16)Ospedale San Raffaele, Milano, Milano, Italy, (17)Los Robles Hospital, Los Angeles, CA
Keywords: TEER/TMVR/Mitral Valve
Background:
There is limited evidence on the feasibility and outcomes of mitral transcatheter edge-to-edge repair (M-TEER) in patients with mitral annular calcification (MAC). This analysis aims to examine the impact of MAC on procedural success and durability of M-TEER.
Methods:
EXPANDed is a patient-level pooled analysis of the EXPAND and EXPAND G4 studies which included patients who underwent M-TEER with the MitraClip G3/G4 Systems between 2018-2022 at 91 sites across the United States, Europe, Canada, the Middle East, and Japan. In this analysis, patients were grouped based on the presence (327 patients) or absence of MAC (no MAC, 1580 patients) at baseline; MAC severity was not assessed. All patients were deemed appropriate for TEER per site discretion.
Results:
Patients with MAC were older (79 years vs. 77 years), had higher STS Replacement Scores (8.9% ± 7.0 vs. 7.6% ± 6.3), higher prevalence of primary MR (62% vs. 44%), had more patients in NYHA class III/IV (79% vs 72%), and were more likely to be female (52% vs 43%). Around 50% of patients had prior heart failure hospitalizations (HFH) within 1 year in both groups.
Acute procedural success was 92% for MAC and 96% for No MAC. All-cause mortality was higher in the MAC group at both 30 days (3.4% vs. 1.7%; p=0.04) and 1 year (18.3% vs. 12.1%; p=0.003). At 1 year, the rate of HFH was 24.2% for MAC patients compared to 16.4% for No MAC (p=0.001). There were no new safety concerns through 1 year, with low rates ( <2.6%) of replacement, SLDA, myocardial infarction, and stroke in both groups. MR regurgitation reductions were similar, with 87.9% and 91.3% of patients having MR ≤1+ at 1 year in the MAC and No MAC, respectively. Quality of life improvements were sustained through year 1, with 81% of patients in NYHA Class I/II in both groups, as well as both groups experiencing large gains (Δ 21.8 ± 26.3, MAC; Δ 19.0 ± 24.5; No MAC) in KCCQ-OS scores. Updated data will be presented at the conference.
Conclusions:
M-TEER is a safe and effective intervention for patients with MAC. Similar MR reduction and quality of life improvements were seen in patients regardless of the presence of MAC. Differences in 1-year mortality and HFH may reflect the complexity and comorbidities of the MAC population.