Patients with mitral regurgitation (MR) and morphologic presence of relevant mitral annular calcification (MAC) represent a challenging phenotypic subset with limited treatment options. The aim of this study was to assess the feasibility of transcatheter mitral valve replacement (TMVR) using dedicated devices for the treatment of MAC patients. Consecutive patients with symptomatic MR receiving TMVR and with available computed tomography data from the CHOICE-MI (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) multicenter registry were stratified by the presence of none or mild mitral annular calcification (MAC) vs moderate or severe mitral annular calcification (MAC). Among 279 eligible patients (median age = 76.0 years [Q1-Q3: 71.0-81.0 years], EuroSCORE II = 6.2% [Q1-Q3: 3.9%-12.1%]), 222 (79.6%) presented with MAC and 57 (20.4%) with MAC. Patients with MAC had a higher prevalence of extracardiac arteriopathy ( 0.011) and primary MR ( 0.001). Although the technical success rate and the extent of MR elimination did not differ, TMVR treatment in MAC patients was associated with higher rates of postprocedural bleeding complications ( 0.02) and renal failure ( 0.001). Functional improvement at the 1- and 2-year follow-up did not differ between groups. At the 2-year follow-up, there were no differences between patients with MAC and MAC regarding all-cause mortality (38.5% vs 37.7%; 0.76), cardiovascular mortality (21.3% vs 24.9%; 0.97), and all-cause mortality or heart failure hospitalization (52.4% vs 46.7%; 0.28) TMVR in patients with MAC is associated with higher rates of postprocedural complications but similar rates of survival, MR resolution, and functional improvement compared to MAC. Further studies are necessary to define the role of dedicated TMVR devices in this population. (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency Registry [CHOICE-MI]; )

中文翻译：

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使用专用装置对二尖瓣环钙化患者进行经导管二尖瓣置换术的结果


患有二尖瓣反流（MR）和形态学上存在相关二尖瓣环钙化（MAC）的患者代表了具有挑战性的表型子集，治疗选择有限。本研究的目的是评估使用专用设备进行经导管二尖瓣置换术 (TMVR) 治疗 MAC 患者的可行性。对连续接受 TMVR 的有症状 MR 患者以及来自 CHOICE-MI（二尖瓣关闭不全的最佳经导管治疗选择）多中心登记处的可用计算机断层扫描数据进行分层，根据是否存在或轻度二尖瓣环钙化 (MAC) 与中度或重度二尖瓣钙化环状钙化（MAC）。在 279 名符合条件的患者中（中位年龄 = 76.0 岁 [Q1-Q3：71.0-81.0 岁]，EuroSCORE II = 6.2% [Q1-Q3：3.9%-12.1%]），222 名（79.6%）患有 MAC，57 名（ 20.4%）与MAC。 MAC 患者心外动脉病 (0.011) 和原发性 MR (0.001) 的患病率较高。尽管技术成功率和 MR 消除程度没有差异，但 MAC 患者的 TMVR 治疗与较高的术后出血并发症 (0.02) 和肾功能衰竭 (0.001) 发生率相关。 1 年和 2 年随访时的功能改善在各组之间没有差异。在 2 年随访中，MAC 和 MAC 患者在全因死亡率（38.5% vs 37.7%；0.76）、心血管死亡率（21.3% vs 24.9%；0.97）和全因死亡率方面没有差异。死亡率或心力衰竭住院率（52.4% vs 46.7%；0.28） MAC 患者的 TMVR 与较高的术后并发症发生率相关，但与 MAC 相比，生存率、MR 分辨率和功能改善率相似。 需要进一步研究来明确专用 TMVR 设备在这一人群中的作用。（二尖瓣关闭不全最佳经导管治疗选择登记 [CHOICE-MI]；）