The Role of Mitral Valve Annular Calcification on Outcomes in Patients with Severe Aortic Stenosis: A Mini-Review

Abstract

Context: Mitral annular calcification (MAC) is commonly observed in patients with severe aortic stenosis (AS); however, its impact on post-intervention outcomes remains debated. Evidence Acquisition: This narrative mini-review synthesizes the available literature on MAC prevalence, associated factors, and outcomes in severe AS. A structured literature search was performed in PubMed, Scopus, and Web of Science. Results: The prevalence of MAC in severe AS ranges from 14.8% to 50.4%, with female sex, older age, atrial fibrillation, and chronic kidney disease consistently identified as risk factors. Severe MAC is associated with significantly worse outcomes. Pergola et al. reported higher major adverse cardiovascular events (MACE; hazard ratio [HR], 2.32) and all-cause mortality (HR, 2.37). Vanhaecke et al. found lower survival (adjusted HR, 1.24). Abramowitz et al. demonstrated increased overall mortality (HR, 1.95) and 1-year mortality (odds ratio [OR], 2.30). However, the evidence is conflicting; Lak et al. found no significant difference in MAC-related mortality. Notably, Mesnier et al. identified MAC with concomitant mitral stenosis (MAC-MS) as an independent predictor of 30-day mortality (HR, 2.30) and 1-year mortality (HR, 1.73), suggesting that MAC alone may not drive poorer outcomes. Conclusions: Severe MAC, particularly when accompanied by mitral stenosis, is associated with a poorer prognosis after valve intervention. Evidence supporting combined transcatheter strategies remains limited to case reports and cannot support broad clinical recommendations.