Long-Term Outcomes After Mitral Valve Replacement in Sex- and Age-Matched Patients With vs Without Mitral Annular Calcification

Abstract

Background

Mitral annular calcification (MAC) portends the need for a technically challenging mitral valve surgery and is associated with poor outcomes after mitral valve replacement (MVR). No study has compared long-term outcomes for patients with vs without MAC in age- and sex-matched cohorts.

Methods

Between 2000 and 2017, a total of 67 patients with MAC who underwent MVR were age- and sex-matched 1:3 with patients with other etiologies without MAC to create a study cohort of 268. An extended Cox regression model was used to investigate long-term outcomes of patients with MAC, compared to those with other mitral etiologies.

Results

The groups were matched for age (MAC, 70.5 years; non-MAC, 70.4 years) and sex (MAC, 61.2% male; non-MAC, 61.7% male). MAC was not a risk factor for 1-year mortality. After 1 year, MAC was an independent risk factor for reduced survival (hazard ratio 2.781, 95% confidence interval 1.642-4.709, P < 0.001). The 5-year and 10-year survival rates were significantly lower in the MAC group than they were in the non-MAC group (5-year: 51.0% ± 6.9% vs 74.6% ± 3.1%; 10-year: 40.1% ± 8.0% vs 51.8% ± 4.1%, P < 0.001). Peripheral vascular disease was the only independent risk factor for both early mortality and reduced long-term survival, and chronic renal failure was a strong independent risk factor for 1-year mortality.

Conclusions

In an age- and sex-matched cohort, patients with MAC have similar early outcomes, but poorer long-term survival following MVR, compared to those without MAC, suggesting that MVR can be performed safely in selected patients with MAC. MAC and PVD are independent risk factors for reduced long-term survival.