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Hou J, Sun Y, Wang H, Zhang L, Shi J, You H, Zhang R, Yang B. Noncontrast cardiac computed tomography-derived mitral annular calcification scores in mitral valve disease. Clin Cardiol 2023; 46:1310-1318. [PMID: 37501607 PMCID: PMC10642324 DOI: 10.1002/clc.24110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND AND AIMS Mitral annular calcification (MAC) by computed tomography (CT) is reported as an independent predictor of poor outcomes. However, it currently remains unclear if quantitative MAC parameters provide more value for mitral valve disease (MVD) management, therefore, we examined the prognostic value of MAC scores using noncontrast cardiac-CT in MVD patients. METHODS Between January 2020 and December 2021, we prospectively enrolled 300 consecutive patients with MVD (MAC-present = 80 and MAC-absent = 220) undergoing preoperative cardiac-CT and mitral valve (MV) surgery. Noncontrast cardiac-CT images were used to qualitatively detect MAC (present or absent) and evaluate MAC scores. For analyses, we also collected baseline clinical data, intraoperative conversion (from MV repair to MV replacement), and follow-up arrhythmia data. RESULTS Compared with the MAC-absent group, MAC-present patients were older (62 ± 7 vs. 58 ± 9 years, p < .001), mostly women (55% vs. 39.5%, p = .017), and also had aortic valve calcification (57.5% vs. 23.2%, p < .001), mitral stenosis (82.5% vs. 61.8%, p < .001), atrial fibrillation (30% vs. 11.8%, p < .001), and larger left atrial end-diastolic dimension (LADD, 49 [44-56] versus 46 [41-50], p = .001]. Furthermore, MAC-present patients underwent more MV replacements (61.8% vs. 82.5%, p = .001) and experienced a higher intraoperative conversion prevalence (11.8% vs. 61.3%, p < .001). Multiple logistic regression analyses showed that the female gender (odds ratio [OR]/95% confidence interval [CI]/p = 2.001/1.042-3.841/0.037) and MAC scores (OR/95% CI/p = 10.153/4.434-23.253/p < .001) were independent predictors of intraoperative conversion. During a follow-up of 263 ± 134 days, MAC-present patients had more arrhythmias (42.5% vs. 9.5%, p < .001). Also, MAC-scores (hazard ratio [HR]/95% CI/p = 6.841/3.322-14.089/p < .001) and LADD (HR/95% CI/p = 1.039/1.018-1.060/p < .001) were independently associated with arrhythmias by Cox regression analyses. CONCLUSIONS Noncontrast cardiac CT-derived MAC-scores showed a high risk for intraoperative conversion and follow-up arrhythmias in MVD-patients.
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Affiliation(s)
- Jie Hou
- College of Medicine and Biological Information EngineeringNortheastern UniversityShenyangLiaoningChina
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Yu Sun
- College of Medicine and Biological Information EngineeringNortheastern UniversityShenyangLiaoningChina
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Huishan Wang
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Libo Zhang
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Jinglong Shi
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Hongrui You
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Rongrong Zhang
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Benqiang Yang
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
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Knox A, Bennetts JS, Gimpel D, Newland RF, Baker RA, Joseph MX, Rice GD, Kangaharan N, Sinhal A. Transcatheter mitral valve-in-valve: treatment of rheumatic heart disease in young patients. ANZ J Surg 2022; 92:3298-3303. [PMID: 36200709 DOI: 10.1111/ans.18076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/28/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve-in-valve (TMViV) replacement has emerged as an alternative to redo surgery in high-risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD. METHODS A single-centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post-operative trans-thoracic echocardiogram (TTE) results. RESULTS There were seven patients with a mean age of 33 years and predominantly female (n = 5). Pre-operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post-operative median length of hospital stay was 4 days with no post-operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post-operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow-up of 22 months. CONCLUSION Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD.
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Affiliation(s)
- Abbey Knox
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Jayme S Bennetts
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Damian Gimpel
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Richard F Newland
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Robert A Baker
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Majo X Joseph
- Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Gregory D Rice
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nadarajah Kangaharan
- Cardiology and Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia
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