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Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease.

Publication ,  Journal Article
Shah, B; Villablanca, PA; Vemulapalli, S; Manandhar, P; Amoroso, NS; Saric, M; Staniloae, C; Williams, MR
Published in: Circ Cardiovasc Interv
February 2019

BACKGROUND: Renal disease is associated with poor prognosis despite guideline-directed cardiovascular therapy, and outcomes by sex in this population remain uncertain. METHODS AND RESULTS: Patients (n=5213) who underwent a MitraClip procedure in the National Cardiovascular Data Registry Transcatheter Valve Therapy registry were evaluated for the primary composite outcome of all-cause mortality, stroke, and new requirement for dialysis by creatinine clearance (CrCl). Centers for Medicare and Medicaid Services-linked data were available in 63% of patients (n=3300). CrCl was <60 mL/min in 77% (n=4010) and <30 mL/min in 23% (n=1183) of the cohort. Rates of primary outcome were higher with lower CrCl (>60 mL/min, 1.4%; 30-<60 mL/min, 2.7%; <30 mL/min, 5.2%; dialysis, 7.8%; P<0.001), and all low CrCl groups were independently associated with the primary outcome (30-<60 mL/min: adjusted odds ratio, 2.32; 95% CI, 1.38-3.91; <30 mL/min: adjusted odds ratio, 4.44; 95% CI, 2.63-7.49; dialysis: adjusted hazards ratio, 4.52; 95% CI, 2.08-9.82) when compared with CrCl >60 mL/min. Rates of 1-year mortality were higher with lower CrCl (>60 mL/min, 13.2%; 30-<60 mL/min, 18.8%; <30 mL/min, 29.9%; dialysis, 32.3%; P<0.001), and all low CrCl groups were independently associated with 1-year mortality (30-<60 mL/min: adjusted hazards ratio, 1.50; 95% CI, 1.13-1.99; <30 mL/min: adjusted hazards ratio, 2.38; 95% CI, 1.78-3.20; adjusted hazards ratio: dialysis, 2.44; 95% CI, 1.66-3.57) when compared with CrCl >60 mL/min. CONCLUSIONS: The majority of patients who undergo MitraClip have renal disease. Preprocedural renal disease is associated with poor outcomes, particularly in stage 4 or 5 renal disease where 1-year mortality is observed in nearly one-third. Studies to determine how to further optimize outcomes in this population are warranted.

Duke Scholars

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Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

February 2019

Volume

12

Issue

2

Start / End Page

e007552

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Renal Dialysis
  • Registries
  • Prosthesis Design
  • Mitral Valve Stenosis
  • Mitral Valve Insufficiency
 

Citation

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Shah, B., Villablanca, P. A., Vemulapalli, S., Manandhar, P., Amoroso, N. S., Saric, M., … Williams, M. R. (2019). Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease. Circ Cardiovasc Interv, 12(2), e007552. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007552
Shah, Binita, Pedro A. Villablanca, Sreekanth Vemulapalli, Pratik Manandhar, Nicholas S. Amoroso, Muhamed Saric, Cezar Staniloae, and Mathew R. Williams. “Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease.Circ Cardiovasc Interv 12, no. 2 (February 2019): e007552. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007552.
Shah B, Villablanca PA, Vemulapalli S, Manandhar P, Amoroso NS, Saric M, et al. Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease. Circ Cardiovasc Interv. 2019 Feb;12(2):e007552.
Shah, Binita, et al. “Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease.Circ Cardiovasc Interv, vol. 12, no. 2, Feb. 2019, p. e007552. Pubmed, doi:10.1161/CIRCINTERVENTIONS.118.007552.
Shah B, Villablanca PA, Vemulapalli S, Manandhar P, Amoroso NS, Saric M, Staniloae C, Williams MR. Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease. Circ Cardiovasc Interv. 2019 Feb;12(2):e007552.

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

February 2019

Volume

12

Issue

2

Start / End Page

e007552

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Renal Dialysis
  • Registries
  • Prosthesis Design
  • Mitral Valve Stenosis
  • Mitral Valve Insufficiency