MitraClip: Should we prescribe it earlier?

Courtesy of Dr. Carlos Fava.

Patients with severe mitral regurgitation unfit for surgery due to high surgical risk are likely to develop chronic kidney disease (CKD). There is limited information available on patients with CKD receiving MitraClip.

This study analyzed patients receiving MitraClip and presenting chronic kidney disease.

CKD was defined as a baseline glomerular filtration rate <60 ml/min/1.73m2 (stages 3 and 4).

Device implantation was considered successful with ≤2+ residual mitral regurgitation. Safety end point was major adverse cardiac events incidence at 30 days and efficacy end point was freedom from death, mitral valve surgery or ≥3 mitral regurgitation + at 12 months.

The study included 214 patients receiving MitraClip; 113 (52.8%) presenting CKD, 91 in stage 3 and 22 in stage 4.

Those presenting CKD were older, more often women, had higher EuroScore and higher STS, had more mitral annulus and valve calcification and more anemia. Ejection fraction, ventricular dimension and functional class were similar between the groups. Implantation success rate was high in both groups (97.3% vs. 99%) with a significant improvement of mitral regurgitation. There were no differences in number of clips, procedural time, contrast and in-hospital stay.

As regards safety end point, at 30 days there were more events in those presenting CKD, basically due to more important deterioration of kidney function. Functional class improvement and mitral regurgitation reduction were similar.

At one year, efficacy end point was lower in the CKD group (65.8% vs. 84.2%; p=0.005) as was freedom from rehospitalization and death. Initial mitral regurgitation and functional class improvement also lowered in this group.

Adverse event predictors were anemia, CKD, functional class IV, mitral regurgitation ≥3+ at 12 months, calcified mitral annulus and calcified valves.

Conclusion
Patients with chronic kidney disease presented worse evolution post MitraClip implantation compared to those with no CKD. Chronic kidney disease was an independent predictor of the efficacy end point while calcified valves were an independent predictor of mitral regurgitation ≥3+ at 12 months.

Editorial Comment
Chronic kidney disease is associated with a reduced benefit of MitraClip implantation at one year; perhaps we should change our strategy and prescribe it before kidneys deterioration, which is associated to calcified annulus and valves.

Courtesy of Dr. Carlos Fava.

Original Title: Impact of Chronic Kidney Disease on Outcome After Percutaneous Mitral Valve Repair With MitraClip System: Insights from the GRASP Registry.

Reference: Yohei Ohno, et al. EuroIntervention 2016;11 :1649-1657.

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