Acute kidney injury (AKI) is a frequent and serious complication in catheter-based procedures. Despite the rare use of contrast, AKI can also occur after percutaneous mitral valve repair. In transcatheter tricuspid repair (TTVR), there is scarce data about the incidence and prognostic impact of AKI.
Methods:
In total, 218 patients undergoing edge-to-edge TTVR were included in the current analysis. AKI was defined as an absolute increase in serum creatinine of ≥ 0.3 mg/dl or a relative increase of ≥50% from baseline to 72 hours after the procedure. Procedural success was defined as a case in which tricuspid regurgitation reduced at least one grade after the procedure. The primary endpoint was defined as composite outcome, consisting of all-cause mortality and re-hospitalization due to worsening heart failure, within one year after TTVR.
Results:
Out of 218 patients (mean age: 79 ±7 years; male: 46.3%; median EuroScore II: 5.4%), AKI occurred in 34 patients (15.6%) after the procedure. Comparing patients with vs without post-procedural AKI, patients with AKI had lower estimated glomerular filtration rate (GFR) (41 vs 48 ml/min/1.73m²; p=0.013) and a higher EuroSCORE II (6.6 vs 5.0%; p=0.022) at baseline. While the type of used device and the procedural time were comparable between the groups, procedural success tended to be less frequent in patients with post-procedural AKI compared to those without AKI (79% vs 91%; p=0.062). In multivariable regression model, lower baseline GFR and procedural failure were predictors of AKI. Regarding primary endpoint, patients with AKI had a higher incidence of the composite outcome within one year after TTVR (62.5% vs. 30.3%; log-rank p<0.001). In multivariable cox-regression analysis, post-procedural AKI was associated with the primary endpoint, irrespectively of male sex, GFR at baseline, EuroScore II, left ventricular ejection fraction, and procedural failure (adjusted hazard ratio: 1.88; 95% CI: 1.00-3.51; p=0.049).
Conclusion:
In patients undergoing edge-to-edge TTVR, AKI occurred in 15.6% of patients which represents a rate comparable to previously reported data regarding transcatheter mitral valve repair. Lower GFR at baseline and procedural failure were associated with the incidence of AKI after TTVR. The incidence of post-procedural AKI was associated with worse outcomes, underlining the importance to monitor and reduce this complication.
Figure:
All-cause mortality and re-hospitalization due to worsening heart failure in patients with vs without acute kidney injury (AKI) after edge-to-edge transcatheter tricuspid repair.
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