Mortality Following TMVr Higher in Patients With Renal Disease, NCDR Study Shows

Patients undergoing transcatheter mitral valve repair (TMVr) with MitraClip who have renal disease may have a significantly higher mortality risk than those without renal disease, according to a study published Feb. 1 in Circulation: Cardiovascular Interventions.

Using data from the STS/ACC TVT Registry, Binita Shah, MD, MS, FACC, et al., evaluated the rates of adverse outcomes in 5,213 patients with renal disease undergoing TMVr at 204 hospitals. The study's primary outcome was the composite of in-hospital all-cause mortality, stroke or new requirement for dialysis based on creatine clearance. The researchers linked patient records to claims data from the Centers for Medicare and Medicaid Services for 3,300 patients to look at 30-day and one-year rates of all-cause mortality, mitral valve reintervention, and readmission related to heart failure or bleeding.

Among all 5,213 patients, baseline creatine clearance levels were > 60 mL/min in 1,203 patients (23 percent); > 30 mL/min but ≤ 60 mL/min in 2,827 (54 percent); and ≤ 30 mL/min in 1,029 (20 percent). In addition, 154 patients (3 percent) were on dialysis at baseline. After the procedure, the primary composite of all-cause mortality, stroke and new dialysis requirement occurred in 1.4 percent of patients with creatine clearance > 60 mL/min; 2.7 percent of patients with creatine clearance > 30 mL/min but ≤ 60 mL/min; 5.2 percent of patients with creatine clearance ≤ 30; and 7.8 percent for patients on dialysis.

Patients with lower creatine clearance had poorer 30-day and one-year outcomes. After 30 days, patients on dialysis had higher rates of all-cause mortality, while patients with creatine clearance ≤ 30 mL/min or on dialysis had significantly higher rates of bleeding. After one year, all-cause mortality occurred in nearly one-third of patients with creatine clearance ≤ 30 mL/min or on dialysis.

The study's findings demonstrate that patients with renal disease have a higher risk of adverse outcomes after TMVr, the authors write, adding that their results "should be incorporated in the patient selection and shared decision-making process." They conclude that future research is "warranted" to determine both the "underlying mechanism of poorer outcomes" after TMVr and the "optimal mitral valve treatment strategy" in these patients.

Keywords: Mitral Valve, Creatine, Renal Dialysis, Patient Readmission, Registries, National Cardiovascular Data Registries, STS/ACC TVT Registry, Kidney, Heart Failure, Stroke

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