Effect of Acute Kidney Injury After Percutaneous Mitral Valve Repair on Outcome

Spieker, Maximilian; Hellhammer, Katharina; Katsianos, Stratis; Wiora, Julian; Zeus, Tobias; Horn, Patrick; Kelm, Malte; Westenfeld, Ralf

doi:10.1016/j.amjcard.2018.03.358

Cited by 31 publications

(24 citation statements)

References 28 publications

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“…The most frequent post‐procedural complications were low cardiac output syndromes and bleedings without evidence for an association with LA diameter. The significant association between LA enlargement and new dialysis might rather be explained by the left atrium as a correlate of advanced cardiac disease and potentially cardio‐renal syndrome than a causal interaction . The same might be expected for the significant association between severe LA enlargement and vascular complications.…”

Section: Discussionmentioning

confidence: 93%

Impact of left atrial diameter on outcome in patients undergoing edge‐to‐edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions (TRAMI) registry

Iliadis

Baldus

Kalbacher

et al. 2020

European J of Heart Fail

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Section: Discussionmentioning

confidence: 93%

Impact of left atrial diameter on outcome in patients undergoing edge‐to‐edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions (TRAMI) registry

Iliadis

Baldus

Kalbacher

et al. 2020

European J of Heart Fail

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“…These changes are accompanied by a reduction of the measured GFR even in the absence of age‐related co‐morbidities. Evidence suggests that chronic kidney disease has been associated with poor long‐term outcomes including increased mortality and hospitalization among patients who underwent PMVR 13,14 …”

Section: Discussionmentioning

confidence: 99%

“…Evidence suggests that chronic kidney disease has been associated with poor long-term outcomes including increased mortality and hospitalization among patients who underwent PMVR. 13,14 In addition to co-morbidities, functional capacity and frailty of the patients have to be considered by the Heart Team for assessing and recommending individual therapy. Over 80% of the nonagenarians who live in households or noninstitutional groups and virtually all (98%) of those residing in institutional group quarters such as nursing homes have some type of disability.…”

Section: Discussionmentioning

confidence: 99%

Two year outcome in nonagenarians undergoing percutaneous mitral valve repair

et al. 2020

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Aims Percutaneous mitral valve repair (PMVR) has emerged as standard treatment in selected patients with clinically relevant mitral regurgitation (MR) and increased surgical risk. We aimed to evaluate the safety and clinical outcomes in nonagenarians undergoing PMVR. Methods and results Altogether, 493 patients with severe MR who were treated with PMVR were included in this open-label prospective study and followed up for 2 years. We treated 25 patients with PMVR aged 90 years or above, 185 patients aged 80-89 years, and 283 patients aged <80 years. PMVR in nonagenarians was safe and did not differ from PMVR in younger patients in terms of safety endpoints. Device success did not differ among the groups (100% in nonagenarians, 95.7% in octogenarians, and 95.1% in septuagenarians, P = 0.100). Unadjusted 2 year mortality was 28% in nonagenarians, 32.4% in octogenarians, and 19.8% in septuagenarians (P = 0.008). Kaplan-Meier curves confirmed similar 2 year survival in the nonagenarian and octogenarian groups (P = 0.657). In the multivariate analysis, age [hazard ratio (HR) 1.031, 95% confidence interval (CI) 1.002-1.060, P = 0.034], higher post-procedural transmitral valve gradients (HR 1.187, 95% CI 1.104-1.277, P = 0.001), and post-procedural acute kidney injury (HR 2.360, 95% CI 1.431-3.893, P = 0.001) were independent predictors of 2 year mortality. Altogether, 89.4% of the nonagenarians, 85.9% of the octogenarians, and 86.4% of the septuagenarians had MR grade of 2+ or less at 1 year after PMVR (P = 0.910). New York Heart Association functional class improved in the vast majority of patients, irrespective of age (P = 0.129). After 1 year, 9.5% of the nonagenarians, 22.3% of the octogenarians, and 25.2% of the septuagenarians (each P = 0.001 compared with baseline) suffered from New York Heart Association Functional Class III or IV. The rate of heart failure rehospitalization in the first 12 months after PMVR did not differ among the groups (16% in the nonagenarians, 16.7% in the octogenarians, and 17.7% in the septuagenarians) (P = 0.954). Quality of life assessed by the Minnesota Living with Heart Failure Questionnaire before and at 1 year after PMVR improved in all age groups (P = 0.001). Conclusions Percutaneous mitral valve repair in carefully selected nonagenarians is feasible and safe with intermediate-term beneficial effects comparable with those in younger patients.

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“…Age, log EuroSCORE, baseline renal function, proBNP levels, serum Hba1c, serum C-reactive protein, diuretic usage and elevated right atrial pressure were the risk factors for post-procedural AKI. The influence of baseline renal function was strong, with 75% of the patients developing AKI having stage 3 CKD stage 3 or worse degrees of baseline GFR before the procedure [ 41 ]. The study, however, did not look at the effect of residual MR post repair and the influence of CKD stage on subsequent post procedural AKI, and long-term renal function.…”

Section: Acute Kidney Injury In the Setting Of Mitral Valve Repairmentioning

confidence: 99%

“…The study, however, did not look at the effect of residual MR post repair and the influence of CKD stage on subsequent post procedural AKI, and long-term renal function. Finally, AKI post procedure was associated with poor long-term outcomes such as higher risk of long-term mortality [ 38 , 41 ]. This is consistent with previous studies showing AKI as a predictor of subsequent mortality in percutaneous coronary interventions and aortic valvular replacements [ 40 , 42 ].…”

Section: Acute Kidney Injury In the Setting Of Mitral Valve Repairmentioning

confidence: 99%

Interrelationship Between Kidney Function and Percutaneous Mitral Valve Interventions: A Comprehensive Review

Dayanand

Ram

et al. 2019

CCR

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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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Effect of Acute Kidney Injury After Percutaneous Mitral Valve Repair on Outcome

Cited by 31 publications

References 28 publications

Impact of left atrial diameter on outcome in patients undergoing edge‐to‐edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions (TRAMI) registry

Impact of left atrial diameter on outcome in patients undergoing edge‐to‐edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions (TRAMI) registry

Two year outcome in nonagenarians undergoing percutaneous mitral valve repair

Interrelationship Between Kidney Function and Percutaneous Mitral Valve Interventions: A Comprehensive Review

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