Impact of Changes in Renal Function on Outcomes Following Mitral Transcatheter Edge-To-Edge Repair.
BACKGROUND: Hemodynamic changes following mitral transcatheter edge-to-edge repair (mTEER) may impact estimated glomerular filtration rate (eGFR), but whether changes in eGFR following mTEER are associated with subsequent clinical outcomes is not known. The objective of the study was to investigate procedure-related changes in eGFR and clinical outcomes following mTEER. METHODS: We studied patients in the Transcatheter Valve Therapy registry undergoing mTEER between 2013 and 2022 with available baseline and discharge eGFR. Multivariable linear regression identified baseline characteristics associated with changes in eGFR following mTEER. Cox proportional hazards models examined the adjusted association between improved (≥10% increase in eGFR), unchanged, and worsened renal function (≥10% decrease in eGFR) and survival at 1 year. RESULTS: Among 48,472 patients undergoing mTEER, 15.7% experienced improved renal function and 13.7% had worsened renal function. Cardiogenic shock within 24 hours, age >80, Black race, diabetes, heart failure within 2 weeks, and female sex were strongly associated with worsened renal function after mTEER. Compared to the group with no change in renal function, improved renal function was associated with a decreased risk of 1-year mortality (adjusted hazard ratio: 0.77; 95% CI 0.69-0.86, p < 0.001), whereas worsened renal function was associated with an increased risk of death at 1 year (adjusted hazard ratio: 2.85; 95% CI 2.64-3.08, p < 0.001). CONCLUSIONS: Approximately 30% of patients experience marked changes in renal function following mTEER.A greater than 10% increase or decrease in eGFR is independently associated with differences in 1-year survival. Careful attention to patients at greatest risk for worsened renal function after mTEER is warranted.
