Impact of Changes in Renal Function on Outcomes Following Mitral Transcatheter Edge-To-Edge Repair

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Hemodynamic alterations post-mitral transcatheter edge-to-edge repair (mTEER) can affect estimated glomerular filtration rate (eGFR).
• The association between mTEER-induced eGFR changes and subsequent clinical outcomes remains unclear.
• This study investigates procedure-related eGFR modifications and their impact on patient survival.

Purpose of the Study:

• To analyze changes in eGFR following mTEER.
• To determine the relationship between eGFR fluctuations and 1-year clinical outcomes, specifically mortality.
• To identify patient characteristics associated with worsened renal function post-mTEER.

Main Methods:

• Analysis of 48,472 patients from the Transcatheter Valve Therapy registry (2013-2022) with baseline and discharge eGFR.
• Multivariable linear regression to identify predictors of eGFR change.
• Cox proportional hazards models to assess the association between eGFR change categories (improved, unchanged, worsened) and 1-year survival.

Main Results:

• 15.7% of patients showed improved renal function, while 13.7% experienced worsened renal function post-mTEER.
• Factors like cardiogenic shock, advanced age, Black race, diabetes, heart failure, and female sex were linked to worsened renal function.
• Improved eGFR correlated with decreased 1-year mortality (aHR 0.77), whereas worsened eGFR significantly increased mortality risk (aHR 2.85).

Conclusions:

• Significant renal function changes occur in approximately 30% of patients after mTEER.
• A >10% change in eGFR is independently associated with altered 1-year survival.
• Vigilant monitoring of high-risk patients for renal function decline post-mTEER is crucial.