B-49 | Mitral Annular Calcification: Prevalence, Characteristics, and Impact on Outcomes Following Transcatheter Aortic Valve Replacement – A Systematic Review and Meta-Analysis

There is a paucity of data on the prognostic impact of mitral annular calcification (MAC) in patients undergoing transcatheter aortic valve replacement (TAVR) with conflicting results being reported by the studies that are published We performed a meta-analysis to assess the short-term and long-term outcomes of MAC in post-TAVR patients. Of 25,407 studies identified after the initial database search, four observational studies comprising of 2,620 patients (2,030 patients in the non-severe MAC arm and 590 patients in the severe-MAC arm) were included in the final analysis Compared to patients with non-severe MAC, severe MAC group was associated with significantly higher incidences of overall bleeding (0.75 [0.57, 0.98], p=0.03, I2=0%) at 30-days. However, no significant difference was observed between the two groups for rest of the 30-day outcomes: all-cause mortality (0.79 [0.42, 1.48], p=0.46, I2=9%), myocardial infarction (1.62 [0.37, 7.04], p=0.52, I2=0%), cerebrovascular accident or stroke (1.22 [0.53, 2.83], p=0.64, I2=0%), acute kidney injury (1.48 [0.64, 3.42], p=0.35, I2=0%), and pacemaker implantation (0.70 [0.39, 1.25], p=0.23, I2=68%). Similarly, follow-up outcomes also showed no significant difference between the two groups: all-cause mortality (0.69 [0.46, 1.03], p=0.07, I2=44%), cardiovascular mortality (0.52 [0.24, 1.13], p=0.10, I2=70%) and stroke (0.83 [0.41, 1.69], p=0.61, I2=22%). The sensitivity analysis, however, demonstrated significant results for all-cause mortality (0.57 [0.39, 0.84], p=0.005, I2=7%) by removing the study by Okuno et al and cardiovascular mortality (0.41 [0.21, 0.82], p=0.01, I2=66%) by removing the study by HM Lak et al. Our meta-analysis corroborates the notion that isolated MAC is not an independent predictor of long-term mortality after TAVR and determines severe MAC to be a strong predictor of mortality at follow-up due to higher incidence of mitral valve dysfunction associated with it.