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

Limited data exist on the occurrence of acute kidney injury (AKI) associated with percutaneous mitral valve repair (PMVR). The objectives of the present study were (1) to assess the prevalence of AKI after MitraClip (Abbott Vascular, Santa Clara, California) implantation, (2) to analyze the predictive factors of AKI, and (3) to evaluate the prognostic value of AKI after PMVR with a view to optimizing the management of high-risk patients. A total of 206 patients (serum creatinine [SCr] 1.3 ± 0.6 mg/dl, estimated glomerular filtration rate 55 ± 24 ml/min) who underwent PMVR were included. AKI was defined as an increase in SCr by ≥0.3 mg/dl within 48 hours or an increase in SCr by ≥1.5 times baseline. AKI was assessed during the first 5 days after MitraClip implantation. The incidence of AKI after MitraClip was 18% and none of the patients required dialysis. Age, logistic EuroSCORE, baseline renal function, N-terminal pro-B-type natriuretic peptide levels, serum glycated hemoglobin A1c, serum C-reactive protein, diuretic usage, and elevated right atrial pressure were the risk factors of AKI. Incidence of AKI was associated with poor outcome. Short-term mortality was increased (30-day mortality rate AKI vs no AKI: 18% vs 1%; p <0.001). Likewise, Kaplan-Meier analysis and log-rank test confirmed reduced long-term survival of patients with AKI (1-year all-cause mortality of patients with AKI vs patients with no AKI: 34% vs 13 %; p <0.001). In conclusion, every fifth patient experienced AKI after MitraClip implantation, which was associated with increased short-term mortality and a more than threefold increase in the risk of death 1 year after PMVR.