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PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to December 25, 2019 for studies discussing SMVR or TMVR in patients with mitral annular calcification; 27 of 1539 articles were selected for final review. TMVR was used in 15 studies. Relevant data were available on 82 patients who underwent hybrid transatrial TMVR, and 354 patients who underwent transapical or transseptal TMVR. Outcomes on SMVR were generally reported as small case series (447 patients from 11 studies); however, 1 large study recently reported outcomes in 9551 patients. Patients who underwent TMVR had a shorter median follow\u2010up of 9 to 12\u00a0months (range, in\u2010hospital\u201219\u00a0months) compared with patients with SMVR (54\u00a0months; range, in\u2010hospital\u2012120\u00a0months). Overall, those undergoing TMVR were older and had higher Society of Thoracic Surgeons risk scores. SMVR showed a wide range of early (0%\u201327%; median 6.3%) and long\u2010term mortality (0%\u201365%; median at 1 year, 15.8%; 5 years, 38.8%, 10 years, 62.4%). The median in\u2010hospital, 30\u2010day, and 1\u2010year mortality rates were 16.7%, 22.7%, and 43%, respectively, for transseptal\/transapical TMVR, and 9.5%, 20.0%, and 40%, respectively, for transatrial TMVR. Mitral annular calcification is a complex disease and TMVR, with a versatile option of transatrial approach in patients with challenging anatomy, offers a promising alternative to SMVR in high\u2010risk patients. However, further studies are needed to improve technology, patient selection, operative expertise, and long\u2010term outcomes.<\/jats:p>","DOI":"10.1161\/jaha.120.018514","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T09:37:02Z","timestamp":1615973822000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":56,"title":["Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular Calcification: A Systematic Review"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1012-7967","authenticated-orcid":false,"given":"Sophia L.","family":"Alexis","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery Mount Sinai Health System New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4865-8114","authenticated-orcid":false,"given":"Aaqib H.","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Medicine Westchester Medical Center Valhalla NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"El\u2010Eshmawi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Mount Sinai Health System New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7770-4450","authenticated-orcid":false,"given":"Isaac","family":"George","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery New York Presbyterian Hospital\/Columbia University Medical Center New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Sengupta","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Mount Sinai Health System New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susheel K.","family":"Kodali","sequence":"additional","affiliation":[{"name":"Division of Cardiology New York Presbyterian Hospital\/Columbia University Medical Center New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1342-9191","authenticated-orcid":false,"given":"Rebecca T.","family":"Hahn","sequence":"additional","affiliation":[{"name":"Division of Cardiology New York Presbyterian Hospital\/Columbia University Medical Center New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar K.","family":"Khalique","sequence":"additional","affiliation":[{"name":"Division of Cardiology New York Presbyterian Hospital\/Columbia University Medical Center New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Zaid","sequence":"additional","affiliation":[{"name":"Department of Cardiology Westchester Medical Center Valhalla NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayra","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Division of Cardiology Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinayak N.","family":"Bapat","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Minneapolis Heart Institute Abbott Northwestern Hospital Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin B.","family":"Leon","sequence":"additional","affiliation":[{"name":"Division of Cardiology New York Presbyterian Hospital\/Columbia University Medical Center New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Mount Sinai Health System New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7219-990X","authenticated-orcid":false,"given":"Gilbert H. 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