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Transcatheter Mitral Valve Implantation In Patients With Chronic Kidney Disease
Ayman Elbadawi1, Mahmoud Abdelghany2, Alexander Dang3
1Section of Cardiology, Baylor School of Medicine, Houston, Texas.
The American Journal of Cardiology
|January 22, 2022
Summary
Trans-septal transcatheter mitral valve implantation (TS-TMVI) in patients with chronic kidney disease (CKD) shows increased risks for cardiogenic shock and acute kidney injury, but not mortality. Patients with CKD had longer hospital stays and higher readmission rates.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Interventional Cardiology
Background:
- Limited data exists on trans-septal transcatheter mitral valve implantation (TS-TMVI) outcomes in patients with chronic kidney disease (CKD).
- CKD is a growing concern, impacting cardiovascular procedures and patient outcomes.
- Understanding these outcomes is crucial for optimizing care for this high-risk population.
Purpose of the Study:
- To evaluate the outcomes of TS-TMVI in patients with CKD compared to those without CKD.
- To identify specific risks and complications associated with TS-TMVI in the CKD population.
- To analyze in-hospital mortality and 30-day readmission rates in matched cohorts.
Main Methods:
- A retrospective analysis of the Nationwide Readmissions Database (2015-2018) was performed.
- Patients undergoing TS-TMVI were identified and stratified by CKD (Stage III or higher).
- Propensity score matching was used to compare outcomes between CKD and non-CKD groups, focusing on in-hospital mortality and 30-day nonelective readmissions.
Main Results:
- Of 2,017 TS-TMVI admissions, 733 (36.34%) had CKD. The number of TS-TMVI procedures in CKD patients increased over time.
- Matched cohorts showed no significant difference in in-hospital mortality (7.8% vs 7.3%).
- Patients with CKD had higher rates of cardiogenic shock (12.3% vs 7.6%), acute kidney injury (35.7% vs 16.7%), and hemodialysis (5.4% vs 1.5%), with longer hospital stays and increased 30-day readmissions (25.8% vs 16.5%).
Conclusions:
- TS-TMVI in patients with CKD is associated with increased risks of cardiogenic shock, worsening renal function requiring hemodialysis, and longer hospital stays.
- Despite these complications, TS-TMVI in CKD patients did not result in increased in-hospital mortality compared to non-CKD patients.
- Higher 30-day readmission rates in CKD patients were primarily driven by bleeding and anemia, highlighting the need for closer post-discharge monitoring.
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