Outcomes of transcatheter aortic valve replacement in patients with mitral annular calcification and concomitant mitral valve dysfunction: A systematic review and meta-analysis

Soban Ahmad, Amman Yousaf, Ghulam Mujtaba Ghumman, Mariam Dvalishvili, Muhammad Junaid Ahsan, Arthur Dilibe, Heidi Lynn Reis, Ahmed Hassaan Qavi, Molly Szerlip, Andrew Michael Goldsweig

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Background: Calcific aortic stenosis is the principal indication for transcatheter aortic valve replacement (TAVR). Comorbid mitral annular calcification (MAC) is often present in patients undergoing TAVR. Limited data exist on the impact of MAC on TAVR outcomes. We conducted a systematic review and meta-analysis to explore the effects of MAC and concomitant mitral valve dysfunction (MVD) on TAVR outcomes. Methods: A comprehensive literature review was conducted using PubMed, Embase, Google Scholar, ClinicalTrials.gov, Scopus, and OVID for studies until March 20, 2023. Using the random-effects Mantel-Haenszel method, we calculated pooled risk ratios (RRs) and their corresponding 95 % confidence intervals (CIs) for all dichotomous variables. Results: Six studies comprising 5822 patients (2541 with MAC [severe MAC (>4 mm thickness) 583; non-severe MAC 1958; 400 with MVD; and 1071 without MVD], 3281 without MAC) met inclusion criteria. At 30 days and 1 year, no significant differences were observed between the overall MAC and no MAC groups in terms of mortality, stroke, and permanent pacemaker implantation. However, MAC with MVD was associated with a higher risk of all-cause mortality compared to MAC without MVD at 30 days (RR = 3.43, 95 % CI 2.04–5.76, P < 0.00001) and at 1 year (RR = 2.44, 95 % CI 1.85–3.20, P < 0.00001). Moreover, the risk of cardiovascular mortality was higher in patients with MAC and MVD compared to those with MAC alone (RR = 2.77, 95 % CI 1.89–4.06, P < 0.00001). Additionally, patients with severe MAC had a higher risk of major bleeding at 30 days compared to the non-severe MAC group (RR = 1.33, 95 % CI 1.04–1.69, P = 0.02). Conclusion: TAVR appears to be safe in patients with non-severe MAC, but severe MAC is associated with a higher risk of major bleeding and concomitant MVD increases the mortality risk in patients undergoing TAVR.

Original languageEnglish (US)
Pages (from-to)99-109
Number of pages11
JournalCardiovascular Revascularization Medicine
Volume61
DOIs
StatePublished - Apr 2024

Keywords

  • Major bleeding
  • Meta-analysis
  • Mitral annular calcification (MAC)
  • Mitral regurgitation
  • Mitral stenosis
  • Mortality
  • Transcatheter aortic valve replacement (TAVR)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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