Impact of chronic kidney disease on outcomes after percutaneous mitral valve repair with the MitraClip system: insights from the GRASP registry

• Published in: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology Vol. 11; no. 14; p. e1649
• Main Authors: Ohno, Yohei, Attizzani, Guilherme F, Capodanno, Davide, Barbanti, Marco, Cannata, Stefano, Dipasqua, Fabio, Immé, Sebastiano, Ministeri, Margherita, Caggegi, Anna, Pistritto, Anna M, Chiarandà, Marta, Ronsivalle, Giuseppe, Giaquinta, Sandra, Mangiafico, Sarah, Scandura, Salvatore, Capranzano, Piera, Tamburino, Corrado, Grasso, Carmelo
• Format: Journal Article
• Language: English
• Published: France 01-04-2016
• Subjects: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation - methods; Humans; Male; Middle Aged; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - surgery; Registries; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - surgery; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 1969-6213
• DOI: 10.4244/EIJV11I14A316

Our aim was to evaluate the impact of baseline chronic kidney disease (CKD) on clinical outcomes after percutaneous edge-to-edge mitral valve repair (PMVR).
Two hundred and fourteen consecutive patients dichotomised by the presence of baseline CKD (n=113) or no-CKD (n=101) had their clinical outcomes compared up to 12-month follow-up. The primary safety endpoint was the incidence of major adverse events and the primary efficacy endpoint was freedom from death, surgery for MV dysfunction, or grade ≥3+ MR. The primary safety endpoint was demonstrated in 12.4% vs. 2.0% in CKD and no-CKD patients, respectively (p=0.003). The primary efficacy endpoint at 12 months was significantly lower in CKD patients (65.8% vs. 84.2%, respectively, log-rank p=0.005). While MR reduction and NYHA functional class improvement were mostly sustained and equivalent up to 12 months in no-CKD patients, they were impaired in CKD patients. Baseline CKD was an independent predictor of the primary efficacy endpoint (adjusted HR 2.48, 95% CI: 1.29 to 4.79, p=0.006) and calcified leaflet predicted grade ≥3+ MR at 12 months (adjusted HR 6.56, 95% CI: 2.71 to 15.88, p<0.001).
CKD patients had worse clinical outcomes compared with no-CKD patients post PMVR. CKD was an independent predictor of the primary efficacy endpoint, whereas calcified leaflet was an independent predictor of grade ≥3+ MR at 12 months.