Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Transcatheter Treatment of Tricuspid Regurgitation and Renal Outcome in Advanced Heart Failure

C. Besler1, L. Stolz2, A. Schöber1, S. Rosch1, M. Näbauer3, M. Unterhuber1, K.-P. Rommel1, K.-P. Kresoja1, S. Massberg3, H. Thiele1, J. Hausleiter3, P. Lurz1

1Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 2Medizinische Klinik und Poliklinik I, LKH Universitätsklinik Graz, München; 3Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München;

Background: Worsening renal function substantially limits optimization of pharmacological therapies and prognosis in patients with heart failure. Venous congestion is a major determinant of renal dysfunction in these patients and aggravated by tricuspid regurgitation (TR). Objectives: The aim of the present study is to assess the effects of transcatheter repair of TR on renal outcome and renal function in inoperable patients with advanced symptoms and signs of right heart failure. Methods: This registry analysis includes patients on maximally tolerated medical heart failure therapy undergoing isolated transcatheter edge-to-edge repair for functional TR. Patients were stratified according to procedural success, defined as TR reduction to mild or moderate. Longitudinal follow-up examinations, including estimated glomerular filtration rate (eGFR) measurements, were scheduled after 1, 6 and 12 months. The effect of procedural success on a composite renal outcome (≥50% sustained decline in eGFR, acute kidney injury, onset of end-stage renal disease requiring hemodialysis) was analyzed. Results: After excluding 82 patients (18 patients on hemodialysis prior to the procedure, 62 patients without creatinine measurements during follow-up, 2 patients with a history of heart transplantation/left ventricular assist device implantation), a total of 441 patients (median age 79.0 years, 51% female, left ventricular ejection fraction ≤40% in 14%, median eGFR 46 ml/min/1.73 m²) entered the final analysis with procedural success achieved in 331 (75%) patients. During a median follow-up of 200 days (IQR: 48-369) the composite renal outcome occurred in 100 (23%) patients. The risk of the composite renal outcome was reduced after successful TR treatment (Log-rank p<0.001, Figure 1), driven by fewer acute kidney injuries. The absolute decline in eGFR after 12 months was less after successful TR reduction (-0.6 vs -15.1 ml/min/1.73 m², Figure 2). A reduction in central venous pressure independently predicted freedom from the composite renal outcome and stable eGFR during follow-up on multivariate analysis. Conclusions: The present data suggest that successful transcatheter treatment of TR improves renal outcome by reducing acute kidney injuries and preventing a decline in renal function over time. This emphasizes TR-based interventions as a novel renal protective approach in advanced heart failure and underscores the need for renal outcomes in the evaluation of device-based heart failure therapies protective approach in advanced heart failure and underscores the need for renal outcomes in the evaluation of device-based heart failure therapies.

https://dgk.org/kongress_programme/jt2023/aP517.html