Author + information
- Marco Ancona1,
- Francesco Giannini1,
- Antonio Mangieri1,
- Damiano Regazzoli2,
- Luciano Candilio3,
- Richard Jabbour4,
- Akihito Tanaka1,
- Francesco Ancona3,
- Eustachio Agricola3,
- Vittorio Romano5,
- Manuela Giglio6,
- Alaide Chieffo1,
- Ottavio Alfieri3,
- Matteo Montorfano7,
- Antonio Colombo8 and
- Azeem Latib1
- 1Interventional Cardiology Institute San Raffaele Hospital, Milan, Milan, Italy
- 2San Raffaele Scientific Institute, Milano, Milan, Italy
- 3San Raffaele Hospital, Milan, Milan, Italy
- 4Imperial College London, London, United Kingdom
- 5Cardiology Intervention Institute San Raffaele Hospital, Milan, Milan, Italy
- 6San Raffaele Scientific Institution, Milan, Milan, Italy
- 7San Raffaele Scientific Institute, Milan, Milan, Italy
- 8Interventional Cardiology Institute San Raffaele Hospital - Stamford Hospital - Columbia University - Centro Cuore Columbus, Milan, Milan, Italy
A high prevalence of Mitral Annular Calcification (MAC) is expected in patients undergoing transcatheter aortic valve implantation (TAVI); however, data regarding the prevalence of MAC and impact on risk of cardiovascular events are lacking. Objectives To determine the prevalence of MAC and its association with clinical outcomes in patients undergoing TAVI.
We retrospectively analysed 424 patients who underwent transfemoral TAVI from 2007 to 2015 and whose pre-operative CT-images were available for assessment of MAC. Severe-Circumferential-MAC (SC-MAC) was defined as calcification involving at least the whole posterior annulus alone or with the attachment of the anterior leaflet. Clinical outcomes were examined according to VARC-2 criteria up to 2-years.
SC-MAC was found in 17.7% of patients. Patients with SC-MAC were more likely to be female, with a higher prevalence of atrial fibrillation and peripheral artery disease (PAD). There were no differences between the groups regarding age, functional class, prevalence of diabetes, kidney disease and operative risk. Female sex and PAD were independent predictors of SC-MAC. SC-MAC did not appear to be associated with peri-procedural and 30-day outcomes. At 2-years follow-up, patients with SC-MAC had significantly higher cardiovascular and all-cause mortality rates (22.3% vs 6.0%, p<0.0001 and 29.8% vs 15.7%, p=0.019 respectively). SC-MAC was an independent predictor of cardiovascular mortality during follow-up (HR 2.94, 95% CI 1.32-6.52, p=0.034).
Severe Circumferential MAC is a frequent finding in the TAVI population and appears to be an independent predictor of cardiovascular mortality at two-years follow-up.
STRUCTURAL: Valvular Disease: Aortic