Prognostic value of mitral annular calcification in patients with severe aortic stenosis

• Published in: Archives of cardiovascular diseases 2025-01, Vol.118 (1), p.S75-S75
• Main Authors: Ben Arbia, H., Sellami, I., Zidi, O., Ferchichi, O., Chalbi, K., Souha, A., Imen, I., Ben Halima, A., Ibn El Hadj, Z., Bennour, E., Kammoun, I.
• Format: Article
• Language: English
• ISSN: 1875-2136
• DOI: 10.1016/j.acvd.2024.10.138

Mitral annular calcification (MAC) is a chronic degenerative process often observed as an incidental finding alongside other cardiac pathologies, complicating surgical intervention and raising morbidity and mortality rates especially in elderly. The aim of our study was to identify the hemodynamic and clinical implications of MAC in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). We conducted a prospective study enrolling patients with severe calcified aortic stenosis who underwent aortic valve replacement via TAVI or SAVR between 2016 and 2023. We evaluated the association between MAC and postoperative complications. Our study included 66 patients with severe aortic stenosis (mean age of 72±10 years). Hypertension was the most prevalent cardiovascular risk factor (56%). In all, 18.1% of patients had a history of coronary artery revascularization. A total, 18.1% had chronic kidney disease (1.5% under dialysis). Three percent had a history of chest radiation exposure. MAC was noted in 25.8%, with 70.6% classified as mild to moderate and 29.4% as severe. Mitral valve disease was observed in 22.2% of patients (moderate in 83.3%, severe in 16.7%). Immediate postoperative cardiovascular complications were noted in 18.2% of patients: 3% had an obstructive prosthesis, 10.6% required emergency pacemaker implantation due to complete atrioventricular block, 3% suffered a stroke, and 9.1% developed heart failure. During follow-up, 13.6% of patients experienced worsening dyspnea, leading to hospitalization in 10.6% of cases. Mortality rate reached 15.2%. Patients with MAC experienced a notably higher rate of immediate postoperative complications compared to those without MAC (47.1% vs. 8.2%, P=0.001). Furthermore, MAC demonstrated significant associations with acute heart failure (P=0.034, OR=7), complete atrioventricular block (P=0.01, OR=9), and aortic regurgitation (P