Edwards SAPIEN in Native Mitral Annular Calcification (MAC)

Patients with symptomatic severe mitral valve disease in the setting of severe mitral annular calcification (MAC) are often elderly with multiple comorbidities and have high risk of cardiovascular death. Transcatheter mitral valve replacement (TMVR) with the compassionate use of aortic transcatheter heart valves (THV) has been utilized as an alternative to surgery. Most of the experience has been with the balloon-expandable Edwards family of THVs, particularly the SAPIEN 3 valve. There are important anatomic features that should be taken in consideration to achieve a successful TMVR for MAC using a balloon-expandable aortic THV. Several THV delivery access types have been utilized including transatrial, transapical, and transseptal. TMVR valve-in-MAC is associated with high risk of LVOT obstruction. There are several early feasibility clinical trials evaluating TMVR with the use of the SAPIEN 3 valve.