Department of Internal Medicine, University of Massachusetts Medical School- Baystate Medical Center, Springfield, Massachusetts.
Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois.
Catheter Cardiovasc Interv. 2021 Mar;97(4):E569-E579. doi: 10.1002/ccd.29188. Epub 2020 Aug 15.
Transcatheter mitral valve repair (TMVR) is a treatment option for patients with 3+ or greater mitral regurgitation who cannot undergo mitral valve surgery. Outcomes in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) are unclear. We sought to evaluate the TMVR in-hospital outcomes, readmission rates and its impact on kidney function.
Data from 2016 National Readmission Database was used to obtain all patients who underwent TMVR. Patients were classified by their CKD status: no CKD, CKD, or ESRD. The primary outcomes were: in-hospital mortality, 30- and 90-day readmission rate, and change in CKD status on readmission. Multivariable logistic regression analysis was used to assess in-hospital, readmission outcomes and kidney function stage.
A total of 4,645 patients were assessed (mean age 78.5 ± 10.3 years). In-hospital mortality was higher in patients with CKD (4.0%, odds ratio [OR]:2.01 [95% CI, confidence interval: 1.27-3.18]) and ESRD (6.6%, OR: 6.38 [95% CI: 1.49-27.36]) compared with non-CKD (2.4%). 30-day readmission rate was higher in ESRD versus non-CKD patients (17.8% vs. 10.4%, OR: 2.24 [95% CI: 1.30-3.87]) as was 90-day readmission (41.2% vs. 21% OR: 2.51 [95% CI:1.70-3.72]). Kidney function improved in 25% of patients with CKD stage 3 and in 50% with CKD stage 4-5 at 30-and 90-day readmission. Incidence of AKI, major bleeding, and respiratory failure were higher in CKD group.
Patients with CKD and ESRD have worse outcomes and higher readmission rate after TMVR. In patients who were readmitted after TMVR, renal function improved in some patients, suggesting that TMVR could potentially improve CKD stage.
经导管二尖瓣修复术（TMVR）是一种治疗三尖瓣以上或以上二尖瓣反流且无法进行二尖瓣手术的患者的选择。慢性肾脏病（CKD）和终末期肾病（ESRD）患者的结局尚不清楚。我们试图评估 TMVR 的住院期间结局、再入院率及其对肾功能的影响。
使用 2016 年国家再入院数据库的数据获取所有接受 TMVR 的患者。根据 CKD 状态对患者进行分类：无 CKD、CKD 或 ESRD。主要结局是：住院期间死亡率、30 天和 90 天再入院率以及再入院时 CKD 状态的变化。多变量逻辑回归分析用于评估住院、再入院结局和肾功能分期。
共评估了 4645 例患者（平均年龄 78.5±10.3 岁）。CKD 患者（4.0%，优势比[OR]：2.01[95%CI，置信区间：1.27-3.18]）和 ESRD 患者（6.6%，OR：6.38[95%CI：1.49-27.36]）的住院死亡率高于非 CKD 患者（2.4%）。与非 CKD 患者相比，ESRD 患者的 30 天再入院率更高（17.8%vs.10.4%，OR：2.24[95%CI：1.30-3.87]），90 天再入院率也更高（41.2%vs.21%，OR：2.51[95%CI：1.70-3.72]）。30 天和 90 天再入院时，30%的 CKD 3 期患者和 50%的 CKD 4-5 期患者的肾功能得到改善。CKD 组 AKI、大出血和呼吸衰竭的发生率较高。
CKD 和 ESRD 患者在接受 TMVR 后结局较差且再入院率较高。在接受 TMVR 后再入院的患者中，一些患者的肾功能得到改善，这表明 TMVR 可能潜在地改善 CKD 分期。
