• Michael I Brener, Mohanad Hamandi, Estee Hong, Alejandro Pizano, Morgan T Harloff, Evan F Garner, Abdallah El Sabbagh, Ryan K Kaple, Arnar Geirsson, David W Deaton, Ashequl M Islam, Ramesh Veeregandham, Vinayak Bapat, Omar K Khalique, Yuming Ning, Paul A Kurlansky, Paul A Grayburn, Tamim M Nazif, Susheel K Kodali, Martin B Leon, Michael A Borger, Raymond Lee, Keshav Kohli, Ajit P Yoganathan, Andrea Colli, Mayra E Guerrero, James E Davies, Kyle W Eudailey, Tsuyoshi Kaneko, Tom C Nguyen, Hyde Russell, Robert L Smith, and Isaac George.
• Division of Cardiology, Columbia University Medical Center, New York, NY.
• J. Thorac. Cardiovasc. Surg. 2024 Apr 1; 167 (4): 12631275.e31263-1275.e3.

ObjectiveImplantation of a transcatheter valve-in-mitral annular calcification (ViMAC) has emerged as an alternative to traditional surgical mitral valve (MV) replacement. Previous studies evaluating ViMAC aggregated transseptal, transapical, and transatrial forms of the procedure, leaving uncertainty about each technique's advantages and disadvantages. Thus, we sought to evaluate clinical outcomes specifically for transatrial ViMAC from the largest multicenter registry to-date.MethodsPatients with symptomatic MV dysfunction and severe MAC who underwent ViMAC were enrolled from 12 centers across the United States and Europe. Clinical characteristics, procedural details, and clinical outcomes were abstracted from the electronic record. The primary end point was all-cause mortality.ResultsWe analyzed 126 patients who underwent ViMAC (median age 76 years [interquartile range {IQR}, 70-82 years], 28.6% female, median Society of Thoracic Surgeons score 6.8% [IQR, 4.0-11.4], and median follow-up 89 days [IQR, 16-383.5]). Sixty-one (48.4%) had isolated mitral stenosis, 25 (19.8%) had isolated mitral regurgitation (MR), and 40 (31.7%) had mixed MV disease. Technical success was achieved in 119 (94.4%) patients. Thirty (23.8%) patients underwent concurrent septal myectomy, and 8 (6.3%) patients experienced left ventricular outflow tract obstruction (7/8 did not undergo myectomy). Five (4.2%) patients of 118 with postprocedure echocardiograms had greater than mild paravalvular leak. Thirty-day and 1-year all-cause mortality occurred in 16 and 33 patients, respectively. In multivariable models, moderate or greater MR at baseline was associated with increased risk of 1-year mortality (hazard ratio, 2.31; 95% confidence interval, 1.07-4.99, P = .03).ConclusionsTransatrial ViMAC is safe and feasible in this selected, male-predominant cohort. Patients with significant MR may derive less benefit from ViMAC than patients with mitral stenosis only.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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