Percutaneous edge-to-edge mitral repair in the presence of mitral annulus calcification

Abstract Background Mitral annular calcification (MAC) is commonly found in patients affected with mitral regurgitation (MR) and it's associated with high morbidity, mortality and worse cardiac surgical outcomes. Transcatheter edge-to-edge mitral valve repair with the MitraClip system has been stablished as a valid alternative to surgery in high risk patients with severe MR. However, its efficacy in patients affected with MAC remains uncertain as this population has been excluded from trials. Objectives To analyze the safety, efficacy and mid-term durability of the treatment of MR with the MitraClip system in patients affected with moderate or severe MAC. Methods Data was obtained from a multicenter spanish registry that prospectively included consecutive patients with MR grade ≥3 undergoing transcatheter mitral valve repair with the MitraClip system. Sixty-one patients with moderate or severe MAC were included in the “MAC” group and 791 with no-or-mild MAC were allocated in the “NoMAC” group. Results Procedural success was similar in both groups (91.8% vs 95.06%, p=0.268, in MAC and NoMAC respectively) with a very low rate of complications beside a higher residual mean gradient in the MAC group (3.0 vs 3.6mmHg, p=0.001). At one-year follow-up, 79.5% of NoMAC and 90.6% of MAC patients had MR grade ≤2 (p=0.129). Only 9 patients (1,14%), all in NoMAC group, required reintervention during follow up. Eighty percent of patients in both groups remained in NYHA functional class ≤II and a significant reduction in readmissions for heart failure was also observed (65% vs 78% respectively, p=0.145). One-year mortality was slightly higher in MAC patients (19.67% vs 11.25%, p=0.050) with no difference in cardiovascular mortality (15.25% vs 9.21%, p=0.129). Conclusions Transcatheter edge-to-edge repair with the MitraClip system in selected patients with moderate or severe MAC is safe and feasible with a mid-term durability similar to those without MAC. These patients also benefit clinically from this treatment with a sustained mid-term subjective clinical improvement and no increase in cardiovascular mortality as compared to NoMAC patients. Funding Acknowledgement Type of funding sources: None.