# Advances in Transcatheter Mitral Valve Replacement (TMVR) in Patients with Mitral Annular Calcification: A Case Report of Acute Hemolytic Anemia and Review of Contemporary Approaches

## TL;DR

This paper discusses a case of acute hemolytic anemia after TMVR in a patient with mitral annular calcification and reviews recent advances in TMVR techniques.

## Contribution

The paper presents a case report and reviews contemporary TMVR approaches, emphasizing challenges and innovations in managing mitral annular calcification.

## Key findings

- Acute hemolytic anemia occurred following TMVR with the Edwards SAPIEN S3 valve in a patient with MAC.
- Recent TMVR advances include novel devices, improved imaging, and strategies to reduce complications like hemolysis.
- Persistent challenges in TMVR for MAC include paravalvular leak and LVOT obstruction, requiring better patient selection and peri-procedural care.

## Abstract

Mitral valve disease, particularly in the context of extensive mitral annular calcification (MAC), poses significant challenges for traditional surgical management. Transcatheter mitral valve replacement (TMVR) has emerged as a promising alternative for high-risk and inoperable patients, driven by rapid advancements in valve technology, imaging techniques, and procedural strategies. Nevertheless, complications such as paravalvular leak (PVL), left ventricular outflow tract (LVOT) obstruction, and hemolysis remain obstacles to optimal outcomes, particularly in patients with complex annular anatomy. We present the case of an 89-year-old female with severe mitral stenosis and MAC who developed acute hemolytic anemia following experimental TMVR using the Edwards SAPIEN S3 valve. This case serves as a platform to explore recent advances in TMVR, including novel device platforms, enhanced imaging modalities for pre-procedural planning, innovative deployment strategies, and emerging adjunctive techniques aimed at reducing complications. Through this case, we underscore persistent challenges and emphasize the importance of meticulous patient selection and vigilant follow-up. Despite substantial progress, TMVR in the setting of MAC remains high-risk, demanding continued innovation in valve design, refined patient stratification, and improved peri-procedural management to enhance outcomes and mitigate risks such as hemolysis.