Transcatheter edge-to-edge repair in patients with mitral annular calcification: A systematic review and meta-analysis.

Abstract

Background: Mitral annular calcification (MAC) is common in patients with functional mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair (TEER). However, the safety and effectiveness of TEER systems in patients with MAC is poorly understood.

Methods: We systematically reviewed multiple online databases to identify studies that reported outcomes in patients undergoing TEER with underlying moderate/severe MAC versus those with no/mild MAC. Random-effect model meta-analysis at a 95 % confidence interval was done via Cochrane Review Manager 5.4.

Results: A total of 6 studies with a pooled 2808 patients (no/mild MAC: 84.5 % vs moderate/severe MAC: 15.5 %) were included. Compared to those with no/mild MAC, patients undergoing TEER with moderate/severe MAC have an insignificant trend towards a lower immediate procedural success (OR: 0.62, 95 % CI: 0.37 - 1.04, p = 0.07). After one year of TEER, the two groups had similar rates of repeat mitral valve intervention or surgery (OR: 1.67, 95 %CI: 0.92 - 3.05, p = 0.09), sustained clinical improvement (NYHA ≤ 2) (OR: 0.86, 95 %CI: 0.64 - 1.15, p = 0.30), and heart failure re-admission (OR: 0.84, 95 %CI: 0.52 - 1.36, p = 0.48). All-cause mortality was, however, higher in the moderate/severe MAC patients (OR: 1.82, 95 %CI: 1.15 - 2.86, p = 0.01).

Conclusions: TEER appears safe and effective in carefully selected patients with significant MAC. A standardized selection algorithm is needed to identify MAC patients that would benefit most from TEER.