Comparison of Outcomes in Patients With and Without Chronic Kidney Disease Undergoing Transcatheter Tricuspid Valve...

Patients with chronic kidney disease (CKD), including end-stage renal disease (ESRD), undergoing transcatheter tricuspid valve replacement (TTVR) may be at increased risk of adverse outcomes. We compared clinical outcomes after TTVR in patients with versus without CKD/ESRD.

We analyzed 145 patients who underwent TTVR for tricuspid regurgitation (TR). Patients were stratified into 2 cohorts: CKD/ESRD (dialysis dependence and/or estimated glomerular filtration rate <30 mL/min/1.73 m²; n = 24) and no CKD/ESRD (n = 121). Baseline characteristics and clinical outcomes were compared.

Patients with CKD/ESRD were slightly younger (76.3 years [IQR, 69.2-78.6] vs 80.8 years [IQR, 73.4-85.0]; P = .48) and had higher body mass index (29.7 kg/m² [IQR, 24.2-32.2] vs 26.8 kg/m² [IQR, 23.2-31.0]; P = .19), with significantly higher Society of Thoracic Surgeons scores (20.8 vs 12.1; P = .002) and right ventricle systolic pressure (47.5 vs 36.0 mm Hg; P < .001). Baseline New York Heart Association functional class III/IV and TR severity were similar between groups. At 30-day follow-up, all-cause mortality was numerically higher in the CKD/ESRD group (8.3% vs 3.3%; P = .25). Residual TR reduction was achieved in 100% of patients in CKD/ESRD group and 97.6% of patients in the non-CKD/ESRD group (P = .99). Functional outcomes were comparable overall; New York Heart Association functional class III/IV persisted in 25.0% vs 19.3% (P = .73) and median Kansas City Cardiomyopathy Questionnaire-Overall Summary scores were similar (45.8 vs 50.5; P = .57). Major bleeding occurred at similar rates between groups (12.5% vs 12.4%; P = .10), whereas new pacemaker implantation was significantly more common in the CKD/ESRD group (29.2% vs 11.6%; P = .04).

TTVR in patients with CKD/ESRD provides comparable functional improvement to that in patients without CKD. However, the patients with CKD/ESRD group have a significantly higher rate of pacemaker implantation, highlighting the need for individualized risk assessment and careful clinical management in this population.