Effect of Renal Impairment on Clinical Outcomes After Mitral Valve Transcatheter Edge-to-Edge Repair
- PMID: 39967218
- PMCID: PMC11840231
- DOI: 10.1016/j.jacasi.2024.10.025
Effect of Renal Impairment on Clinical Outcomes After Mitral Valve Transcatheter Edge-to-Edge Repair
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.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
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.
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