Results of a new analysis show that patients with mitral annular calcification (MAC) who undergo minimally invasive mitral transcatheter edge-to-edge repair (M-TEER) experience similar relief in mitral regurgitation (MR) and improved quality of life compared to that seen in patients without calcification. Researchers presented their latest data today at the Society of Cardiovascular Angiography and Interventions (SCAI) 2026 Scientific Sessions and Canadian Society of Interventional Cardiology/Consortium on Cardiac Interventions (CAIC-ACCI) Summit in Montreal.
MAC occurs when calcium builds up in a ring of tissue known as the annulus, which supports the heart’s mitral valve. This buildup can affect how the valve closes, leading to complications such as symptomatic mitral regurgitation, where blood flows backwards toward the heart, leading to a reduced quality of life. Patients with severe symptoms who are considered high risk for surgery may undergo M-TEER. M-TEER is a minimally invasive procedure that places a small clip on the mitral valve to help it close more tightly and reduce the amount of blood flowing back into the heart. There is limited evidence regarding the feasibility and outcomes of M-TEER in patients with MAC.
For the EXPANDed trial, researchers analyzed data from the EXPAND and EXPAND G4 trials, which included patients who received M-TEER with the MitraClip™ G3 or G4 system (Abbott) at 91 sites in the United States, Europe, Canada, the Middle East, and Japan between 2018 and 2022. Of the 1,907 patients who participated, 327 had MAC. These patients were older, had a higher surgical risk, had a higher prevalence of primary MR, and were more likely to be female. Additionally, half of the patients in both groups had been hospitalized for heart failure within the previous year.
This study found that the acute surgical success rate was higher in the calcification-free group (96% vs. 92%). All-cause mortality was higher in the MAC group at 30 days (3.4% vs. 1.7%, p=0.04) and at 1 year (18.3% vs. 12.1%, p=0.003). MAC patients also had a higher rate of heart failure hospitalization after 1 year (24.2% vs. 16.4%, p=0.001). In both groups, exchange rates were low and there were no safety concerns throughout the year, including single-leaflet device attachment, myocardial infarction, and stroke. The reduction in MR was similar, with 87.9% of MAC patients and 91.3% of non-MAC patients being ≤1+ at 1 year. Quality of life also significantly improved in both groups and was maintained throughout the year, with 81% of patients having mild or no symptoms during normal activities (defined as NYHA class I/II). Patients also experienced a significant increase in KCCQ-OS (Kansas City Cardiomyopathy Questionnaire – Global Overview, which measures how heart failure patients feel and function in daily life) scores (21.8 ± 26.3 with MAC and 19.0 ± 24.5 without MAC).
It is known that the presence of mitral annular calcification may complicate mitral valve disease. However, this first large-scale real-world study shows that MitraClip surgery is a safe and effective option for patients with severe symptoms, leading to significant reductions in mitral regurgitation and significant improvements in quality of life, regardless of the presence or absence of MAC. The observed differences in 1-year mortality and heart failure hospitalization likely reflect the burden and complexity of comorbidities in patients with MAC compared with those without calcification. ”
Karim Al Azizi, MD, FSCAI, interventional cardiologist at Baylor Scott & White in Plano, Texas
The researchers noted that not all registries currently capture data on MAC, leading to further sub-analyses to determine whether certain patient groups within the MAC population may benefit more than others.
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Society of Cardiovascular Angiography and Interventions
