Patients with severe mitral annular calcification (MAC) who cannot undergo surgery are able to safely receive intravascular lithotripsy (IVL)-facilitated percutaneous balloon mitral valvuloplasty (PBMV), a new study reveals. The study also shows that IVL-facilitated PBMV significantly reduces mitral valve gradients. These data were reported by Gennaro Giustino, MD, of the Henry Ford Hospital, Detroit, and colleagues, in a research letter published Wednesday online in JACC: Cardiovascular Interventions. MAC typically causes severe mitral stenosis (MS) in elderly patients and is difficult to treat. Valve-in-valve MAC is often proposed for this patient population, but many patients cannot undergo the procedure due to obstruction risk of the left ventricular outflow track (LVOT). IVL has not been useful in transcatheter valve-in-MAC but may facilitate PBMV for treatment of calcified MS. Patients (n=24, mean age=77.8±9.0 years, 62.5% female) with severe MAC and severe MS were included in the single-center study between 2019 and 2023, and none were suitable for cardiac surgery. This population was at high risk for LVOT obstruction, as the median predicted neo-LVOT area post-transcatheter mitral valve replacement was 24 mm2 (interquartile range=0-112). The Boston Scientific Sentinel device was used in 70% of the procedures. All patients, except three, received subsequent PBMV. Intraprocedural transesophageal echocardiography assessed the post-PBMV mean gradient and reported an average of 4.8±2.5 mmHg (95% confidence interval [CI]= -7.2 to -3.7 mmHg; p<0.0001). One patient showed worsened mitral regurgitation from baseline. At discharge, all patients were alive. Some limitations of this study include the single-center retrospective design, as well as no inclusion of a control group. In addition, no long-term clinical or echocardiographic follow-ups were conducted, the hemodynamic effect of IVL alone was not evaluated, and the investigators did not characterize the patients’ MAC in detail. In the case of highly symptomatic, high-risk MAC and severe MS patients, IVL-PBMV was safe and efficient. IVL-PBMV reduced the mitral valve gradients and did not increase MR. The investigators in this study suggested the use of embolic protection during these procedures in future studies. Source: Giustino G, Fang JX, Villablanca PA, et al. Intravascular Lithotripsy-Facilitated Balloon Valvuloplasty for Severely Calcified Mitral Valve Stenosis. JACC Cardiovasc Interv. 2023 Dec 20 (Article in press). Image Credit: iushakovsky – stock.adobe.com