Surgical and transcatheter mitral valve replacement in mitral annular calcification: A systematic review

Sophia L. Alexis, Aaqib H. Malik, Ahmed El-Eshmawi, Isaac George, Aditya Sengupta, Susheel K. Kodali, Rebecca T. Hahn, Omar K. Khalique, Syed Zaid, Mayra Guerrero, Vinayak N. Bapat, Martin B. Leon, David H. Adams, Gilbert H.L. Tang

Research output: Contribution to journalArticlepeer-review


Mitral annular calcification with mitral valve disease is a challenging problem that could necessitate surgical mitral valve replacement (SMVR). Transcatheter mitral valve replacement (TMVR) is emerging as a feasible alternative in high-risk patients with appropriate anatomy. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to December 25, 2019 for studies discussing SMVR or TMVR in patients with mitral annular calcification; 27 of 1539 articles were selected for final review. TMVR was used in 15 studies. Relevant data were available on 82 patients who underwent hybrid transatrial TMVR, and 354 patients who underwent transapical or transseptal TMVR. Outcomes on SMVR were generally reported as small case series (447 patients from 11 studies); however, 1 large study recently reported outcomes in 9551 patients. Patients who underwent TMVR had a shorter median follow-up of 9 to 12 months (range, in-hospital‒19 months) compared with patients with SMVR (54 months; range, in-hospital‒120 months). Overall, those undergoing TMVR were older and had higher Society of Thoracic Surgeons risk scores. SMVR showed a wide range of early (0%–27%; median 6.3%) and long-term mortality (0%–65%; median at 1 year, 15.8%; 5 years, 38.8%, 10 years, 62.4%). The median in-hospital, 30-day, and 1-year mortality rates were 16.7%, 22.7%, and 43%, respectively, for transseptal/transapical TMVR, and 9.5%, 20.0%, and 40%, respectively, for transatrial TMVR. Mitral annular calcification is a complex disease and TMVR, with a versatile option of transatrial approach in patients with challenging anatomy, offers a promising alternative to SMVR in high-risk patients. However, further studies are needed to improve technology, patient selection, operative expertise, and long-term outcomes.

Original languageEnglish (US)
Article numbere018514
JournalJournal of the American Heart Association
Issue number7
StatePublished - 2021


  • Mitral annulus calcification
  • Mitral valve
  • Mitral valve replacement
  • Transcatheter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Surgical and transcatheter mitral valve replacement in mitral annular calcification: A systematic review'. Together they form a unique fingerprint.

Cite this