Impact of mitral annulus calcification and associated mitral stenosis on clinical outcomes of transcatheter aortic valve replacement

We sought to assess the impact of mitral annular calcification (MAC) and associated mitral stenosis (MAC-MS) on clinical outcomes of transcatheter aortic valve replacement (TAVR). MAC is a common finding in patients undergoing TAVR. Studies evaluating the impact of MAC on the outcomes of TAVR have yielded conflicting results. Furthermore, the impact of MAC-MS remains unknown. We evaluated all the patients who consecutively underwent TAVR in our institution between January 2008 and May 2018. The presence of MAC was confirmed on computed tomography (CT). The combination of MAC and a mean transmitral gradient ≥ 5 mmHg defined MAC-MS. The study included 1177 patients, of whom 504 (42.8%) had. Patients with MAC had similar outcomes after TAVR than those without except for a higher rate of permanent pacemaker implantation which more frequently occurred in MAC patients (adjusted HR: 1.32, 95%CI: 1.03–1.69, P = 0.03). Similar findings were observed when only patients with severe MAC were selected. Among MAC patients, 85 (7.2%) had MAC-MS. Compared to no–MAC patients, MAC-MS was an independent predictor of all-cause mortality at 30 days (adjusted HR: 2.30,95%CI: 1.08–4.86, P = 0.03) and 1–year (adjusted HR: 1.73, 95%CI: 1.04–2.89, P = 0.04). MAC is a common finding in patients treated with TAVR and even severe does not impact on most clinical outcomes. However, when associated with MS, it is an independent predictor of all-cause mortality and cardiovascular mortality at 1 year. In patients with MAC, the measurement of the transmitral gradient is simple, reproducible and effective to identify those at high early and late risk after TAVR.