Tricuspid failure (TF) mostly affects the elderly and, because of this, is associated with comorbidities that increase surgical risk.
Tricuspid edge to edge repair (TEER) has surged as a valid alternative for the mitral valve in high-risk patients and, at present, is increasingly being used for tricuspids.
One of the complications following TEER is acute kidney injury (AKI), which in case of edge-to-edge repair happens in 1 every 6 patients and has prognostic impact.
This complication has not yet been well assessed for right atrioventricular valves undergoing TEER.
This is a retrospective registry of two centers in Germany including 268 patients with TF undergoing TEER with MitraClip, TriClip or Pascal. 42 of these patients presented AKI (15.7%).
Primary end point was all cause mortality and hospitalization for cardiac failure at 12 months.
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The populations were similar: mean age was 79, 25% were diabetic, 82% hypertensive, 42% had CAD, 23% MI, 21% CABG, 11% stroke, 88% atrial fibrillation and NT-proBNP 2.022 pg/mL.
Patients presenting AKI were older (81 vs. 78 p=0.01), proportionally more were men (64.3% vs. 39,4% p=0.003), they had lower glomerular filtration 44.8 vs 51.4 (p=0.088) and higher EuroScore (7.98 vs. 4.9 p=0.003).
They had complete medical treatment.
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Most procedures were done under general anesthesia. The most common device was MitraClip/TriClip, device failure was 5.6% and procedural success was 88.4%. Patients presenting AKI saw lower procedural success (79.3 vs. 90.6% p=0.03).
Hospital mortality was higher in patients presenting AKI (9.5% vs. 0.9% p=0.006) as was bleeding and longer hospital stay.
Primary end point at 12 months was higher among patients presenting AKI (66.2% vs 28.1%; P < 0.001).
AKI predictors were age, male sex, eGFR, left ventricular ejection fraction and procedural success.
Conclusion
Acute kidney injury occurred in 15.7% of patients undergoing tricuspid transcatheter edge to edge repair despite no use of iodinated contrast agents. This situation was associated with worse evolution.
These findings manifest the impact of acute kidney injury after transcatheter edge to edge repair of the tricuspid valve and should help identify patients at risk of acute kidney injury.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Acute Kidney Injury Following Tricuspid Transcatheter Edge-to-Edge Repair.
Reference: Tetsu Tanaka, et al. J Am Coll Cardiol Intv 2022;15:1936–1945.
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