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. 2025 Feb;5(2):273-282.
doi: 10.1016/j.jacasi.2024.10.025. Epub 2025 Jan 14.

Effect of Renal Impairment on Clinical Outcomes After Mitral Valve Transcatheter Edge-to-Edge Repair

Affiliations

Effect of Renal Impairment on Clinical Outcomes After Mitral Valve Transcatheter Edge-to-Edge Repair

Kazuki Tanaka et al. JACC Asia. 2025 Feb.

Abstract

Background: Renal impairment is associated with poor clinical outcomes in patients with cardiovascular diseases. Some studies have revealed the impact of renal impairment on the clinical outcomes of patients who underwent mitral valve transcatheter edge-to-edge repair (M-TEER). However, limited data are available regarding the impact of baseline renal impairment after M-TEER in Asian-Pacific patients with heart failure and severe mitral regurgitation.

Objectives: This study sought to examine the effect of renal impairment on clinical outcomes after M-TEER using a large-scale nationwide registry in Japan.

Methods: A total of 2,150 patients enrolled in the OCEAN-Mitral (Optimized Catheter Valvular Intervention) registry were divided into 3 groups according to the estimated glomerular filtration rate (eGFR) before M-TEER: normal eGFR (≥60 mL/min/1.73 m2) (n = 291), renal impairment (<60 mL/min/1.73 m2) (n = 1,746), and dialysis (n = 113). The impact of renal impairment and dialysis on major adverse cardiovascular events (MACE) (a composite of all-cause death and hospitalization for heart failure) was examined.

Results: Kaplan-Meier analysis revealed that the renal impairment and dialysis groups had a significantly higher incidence of MACE (survival rates at 2 years: normal eGFR, 74.2% [95% CI: 66.9%-80.1%] vs renal impairment, 63.9% [95% CI: 61.0%-66.6%] vs dialysis, 50.9% [95% CI: 38.2%-62.2%]; P < 0.001). Multivariate Cox regression analysis identified dialysis as the strongest independent predictor of MACE (HR: 1.95; 95% CI: 1.33-2.85; P < 0.001).

Conclusions: Renal impairment was associated with an increased incidence of major adverse events, and dialysis was the strongest independent predictor of poor clinical outcomes after M-TEER in Asian-Pacific patients.

Keywords: heart failure; major adverse cardiovascular event(s); mitral regurgitation; mitral valve transcatheter edge-to-edge repair; renal impairment.

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Conflict of interest statement

Funding Support and Author Disclosures The OCEAN-Mitral registry, which is part of the OCEAN-SHD registry, was supported by Edwards Lifesciences, Medtronic Japan, Boston Scientific, Abbott Medical Japan, and the Daiichi-Sankyo Company. The sponsors were not involved in the study, data collection, statistical analyses, or manuscript writing. Dr Yamaguchi is a clinical proctor of transcatheter edge-to-edge repair at Abbott Medical; and has received a lecture fee and a scholarship donation from Abbott Medical. Drs. Kubo, Saji, Izumo, Watanabe, Asami, Yamamoto, Nakajima, Amaki, Ohno Enta, Shirai, Mizuno, Naganuma, Bota, Ueno, Mizutani, and Hayashida are clinical proctors of transcatheter edge-to-edge repair at Abbott Medical. Drs. Kubo, Saji, Izumo, Watanabe, and Amaki have received consultant fees from Abbott Medical. Drs. Asami, Yamamoto, and Nakajima have received lecture fees from Abbott Medical. Dr Kodama has received speaker fees from Abbott Medical. Dr Ohno has received consultant, advisor, and speaker fees from Abbott Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Patient’s Flow The 2,150 patients undergoing mitral valve transcatheter edge-to-edge repair using MitraClip were categorized into 3 groups according to their renal function as follows: normal estimated glomerular filtration rate (eGFR) group: n = 291, 13.5%; renal impairment group: n = 1,746, 81.2%; and dialysis group: n = 113, 5.3%. The etiology of mitral regurgitation (MR) in each group was also noted.
Figure 2
Figure 2
Kaplan-Meier Analysis for the Endpoints Kaplan-Meier analysis revealed that patients with renal impairment and those on dialysis had a significantly higher incidence of major adverse cardiovascular event (MACE) (A), all-cause death (B), and heart failure (HF) hospitalization (C) than those with normal estimated glomerular filtration rate (eGFR). M-TEER = mitral valve transcatheter edge-to-edge repair.
Figure 3
Figure 3
Kaplan-Meier Analysis for MACE in FMR and DMR Comparison of functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR). Patients on dialysis showed a higher incidence of MACE than those with normal eGFR and renal impairment in the FMR (A) and DMR (B) groups. Abbreviations as in Figure 2.
Central Illustration
Central Illustration
The Prevalence and Outcomes of Renal Impairment in Mitral Valve Transcatheter Edge-to-Edge Repair Patients Baseline renal impairment was associated with an increased incidence of major adverse cardiovascular events (MACE) after mitral valve transcatheter edge-to-edge repair (M-TEER) for severe mitral regurgitation. Dialysis was the strongest predictor of MACE. eGFR = estimated glomerular filtration rate; HF = heart failure.

References

    1. Nkomo V.T., Gardin J.M., Skelton T.N., Gottdiener J.S., Scott C.G., Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368:1005–1011. - PubMed
    1. Benjamin E.J., Virani S.S., Callaway C.W., et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018;137:e67–e492. - PubMed
    1. Yeo I., Kim L.K., Wong S.C., et al. Relation of hospital volume with in-hospital and 90-day outcomes after transcatheter mitral valve repair using MitraClip. Am J Cardiol. 2019;124:63–69. - PubMed
    1. Nishimura R.A., Otto C.M., Bonow R.O., et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;70:252–289. - PubMed
    1. Calafiore A.M., Iaco A.L., Tash A., Abukudair W., Di Mauro M. Mitral valve surgery for functional mitral regurgitation in patients with chronic heart failure—update of the results. Thorac Cardiovasc Surg. 2010;58:131–135. - PubMed