This review seeks to highlight the pathophysiologic phenomena implicated in vascular and valvular calcification and summarize the literature available regarding the use of bisphosphonates in animal and human models. We also discuss novel treatment approaches for vascular calcification, with emphasis on chronic kidney disease and calciphylaxis.
Percutaneous mitral valve repair is emerging as a reasonable alternative especially in
those with an unfavorable surgical risk profile in the repair of mitral regurgitation. At this time, our
understanding of the effects of underlying renal dysfunction on outcomes with percutaneous mitral
valve repair and the effects of this procedure itself on renal function is evolving, as more data
emerges in this field. The current evidence suggests that the correction of mitral regurgitation via
percutaneous mitral valve repair is associated with some degree of improvement in cardiac
function, hemodynamics and renal function. The improvement in renal function was more significant
for those with greater renal dysfunction at baseline. The presence of Chronic Kidney Disease
(CKD) in turn has been associated with poor long-term outcomes including increased mortality and
hospitalization among patients who undergo percutaneous mitral valve repair. This was true regardless
of the degree of improvement in GFR post repair advanced CKD. The adverse impact of CKD
on long-term outcomes was consistent across all studies and was more prominent in those with
GFR<30 mL/min/1.73 m². It is clear that from these contrasting evidences of improved renal function
post mitral valve repair but poor long-term outcomes including increased mortality in patients
with CKD, that proper patient selection for percutaneous mitral valve repair is key. There is a need
to have better-standardized criteria for patients who should qualify to have percutaneous mitral
valve replacement with Mitraclip. In this new era of percutaneous mitral valve repair, much work
needs to be done to optimize long-term patient outcomes.
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