Transcatheter Mitral Valve Implantation In Patients With Chronic Kidney Disease

There is a paucity of data regarding the outcomes of trans-septal transcatheter mitral valve implantation (TS-TMVI) in patients with chronic kidney disease (CKD). We queried the Nationwide Readmissions Database (2015 to 2018) for patients undergoing TS-TMVI. We identified patients with CKD (Stage III or higher). We conducted propensity score matching analysis to compare the outcomes in patients with CKD versus patients without CKD. The main outcomes were in-hospital mortality and 30-day nonelective readmissions. From 2015 to 2018, there were 2,017 admissions for patients receiving TS-TMVI, of whom 733 (36.34%) had CKD. In the CKD group, 76 (10.4%) required chronic dialysis. During the study years, the number of TS-TMVI procedures increased in patients with CKD (p_trend <0.001). Patients with CKD were older and less likely to be women. There was no difference in in-hospital mortality in those with versus without CKD in the matched cohorts (7.8% vs 7.3%; odds ratio 1.09; 95% confidence interval 0.64 to 1.80). Subgroup analysis showed no interaction between chronic dialysis status and in-hospital mortality after TS-TMVI. In the matched cohort, TS-TMVI in those with CKD was associated with higher rates of cardiogenic shock (12.3% vs 7.6%, p = 0.03), acute kidney injury (35.7% vs 16.7%, p <0.001), hemodialysis (5.4% vs 1.5%, p = 0.01) and longer median length of stay, (7 [12] vs 5 [8] days, p <0.001). Patients with CKD were more likely to have 30-day nonelective readmission (25.8% vs 16.5%, p = 0.01), driven by more readmissions for bleeding/anemia. In conclusion, TS-TMVI in patients with CKD is associated with increased risk for cardiogenic shock, worsening renal function requiring hemodialysis, without increased risk of mortality when compared with patients without CKD. Also, there was a higher length of stay and 30-day readmission rate in patients with CKD versus patients without CKD.