Impact of mitral intervention on outcomes of patients with mitral valve dysfunction and annulus calcification

Nahoko Kato, Patricia A. Pellikka, Christopher G. Scott, Alexander T. Lee, Vaibhav Jain, Mackram F. Eleid, Mohamad A. Alkhouli, Guy S. Reeder, Hector I. Michelena, Sorin V. Pislaru, Gabor Bagameri, Juan A. Crestanello, Charanjit S. Rihal, Mayra Guerrero

Research output: Contribution to journalArticlepeer-review


Objectives: To compare all-cause mortality in patients with mitral annulus calcification (MAC) and severe mitral valve dysfunction (MVD) who received standard mitral intervention versus no intervention. Background: Patients with MAC often have high surgical risk due to advanced age, comorbidities, and technical challenges related to calcium. The impact of a mitral intervention on outcomes of patients with MAC and severe MVD is not well known. Methods: Retrospective review of patients with MAC by transthoracic echocardiography (TTE) in 2015 at a single institution. Patients with severe mitral stenosis (MS) or regurgitation (MR) were analyzed and stratified into two groups: surgical or transcatheter intervention performed <1 year after the index TTE, and no or later intervention. The primary endpoint was all-cause mortality. Results: Of 5502 patients with MAC, 357 had severe MVD (MS = 27%, MR = 73%). Of those, 108 underwent mitral intervention (surgery = 87; transcatheter = 21). They were younger (73 ± 11 vs. 76 ± 11 years, p < 0.01) and less frequently had cardiovascular diseases compared with no-intervention. Frequency in women was similar (45% vs. 50%, p = 0.44). During median follow-up of 3.2 years, the intervention group had higher estimated survival than those without intervention (80% vs. 72% at 1 year and 55% vs. 35% at 4 year, p < 0.01). Adjusted for age, eGFR, LVEF < 50%, and pulmonary hypertension, mitral intervention was an independent predictor of lower mortality (hazard ratio = 0.66, 95% confidence interval 0.43–0.99, p = 0.046). Conclusion: Patients with MAC and severe MVD who underwent mitral intervention <1 year from index TTE had lower mortality than those without intervention. Mitral intervention was independently associated with lower mortality.

Original languageEnglish (US)
Pages (from-to)1807-1816
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Issue number6
StatePublished - May 1 2022


  • echocardiography
  • mitral annulus calcification
  • mitral regurgitation
  • mitral repair
  • mitral replacement
  • mitral stenosis
  • transcatheter mitral intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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