Acute kidney injury occurred in more than 15% of transcatheter tricuspid repair procedures
Despite no use of iodinated contrast agents, acute kidney injury happened in more than 15% of patients who underwent transcatheter edge-to-edge repair for tricuspid regurgitation, according to a retrospective analysis.
Those with acute kidney injury (AKI) were more likely than those without it to die or be readmitted for HF within 1 year of the procedure, according to the researchers.
For the analysis, presented at the European Society of Cardiology Congress and simultaneously published in JACC: Cardiovascular Interventions, Tetsu Tanaka, MD, research fellow at Heart Center Bonn, Germany, and colleagues considered 268 consecutive patients (mean age, 79 years; 43% men) who underwent transcatheter edge-to-edge repair (TEER; MitraClip/TriClip, Abbott; Pascal, Edwards Lifesciences) without iodinated contrast agents for tricuspid regurgitation at two centers from September 2015 to June 2021.
“Acute kidney injury is one of the common measured complications of catheter-based procedures, which is strongly associated with morbidity and mortality,” Tanaka said during a presentation. “Recently, a considerable risk of AKI following non-contrast catheter procedures has been recognized. Little is known about the incidence and prognostic impact of AKI for TEER in the setting of [tricuspid regurgitation].”
Postprocedural AKI was defined as an increase in serum creatinine of at least 0.3 mg/dL at 48 hours or a 50% increase in serum creatinine from baseline at 7 days. The outcome of interest was all-cause mortality or HF hospitalization at 1 year.
Among the cohort, 15.7% had AKI after their procedure, according to the researchers.
Predictors of AKI included age, male sex, estimated glomerular filtration rate less than 60 mL/min/1.73 m2 and absence of procedural success, Tanaka and colleagues found.
In-hospital mortality occurred in 9.5% of patients with AKI and in 0.9% of those without it (P = .006), according to the researchers.
In addition, AKI was associated with increased risk for the outcome of interest (adjusted HR = 2.39; 95% CI, 1.45-3.94; P = .001).
“The incidence of AKI was associated with worse clinical outcomes,” Tanaka said during the presentation.
In a related editorial published in JACC: Cardiovascular Interventions, Bernard Chevalier, MD, and Antoinette Neylon, MD, both from Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France, wrote that: “As in mitral repair, an optimal TEER result is clearly a favorable factor to avoid AKI. This emphasizes the crucial role of screening in terms of anatomic and hemodynamic evaluation with specific attention to right ventricular function.
“A thorough early follow-up of renal function after TEER is useful to detect AKI,” they wrote. “Postprocedural AKI may be regarded as a polyfactorial marker of poor prognosis that integrates with the appropriateness of edge-to edge repair indication, efficacy of the procedure to reduce the regurgitation and periprocedural hemodynamic conditions. The presence of even mild AKI may itself be considered a warning sign for subsequent patient management.”
References:
- Chevalier B, et al. JACC Cardiovasc Interv. 2022;doi:10.1016/j.jcin.2022.08.018.
- Tanaka T, et al. JACC Cardiovasc Interv. 2022;doi:10.1016/j.jcin.2022.06.005.
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Tanaka T, et al. Abstract 81110. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).
