Introduction: Impaired renal function, a well-recognized complication of severe heart failure is associated with adverse outcomes following cardiovascular interventions. There are conflicting data reported about its impact on late all-cause mortality following transcatheter edge-to-edge mitral valve repair (TEER) with MitraClip (MC) implantation.
Aim: To evaluate the impact of pre- and post- procedural renal dysfunction on late (≥12 months) all-cause mortality following TEER with MC.
Methods: Electronic databases PubMed, Embase, and Web of Science were systematically reviewed from inception to February 2021 for studies evaluating MC outcomes, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A random-effects model meta-analysis was performed and heterogeneity of the included studies was assessed using I-squared test.
Results: Out of 2606 articles, 15 studies with 19,545 patients were included. Pre-procedural renal dysfunction i.e. chronic kidney disease (CKD) was independently associated with higher late all-cause mortality (Hazard ratio [HR] 1.57, 95% CI 1.25-1.97, I2 = 57%) after TEER with MC. A similar association was observed irrespective of CKD severity (HR 1.62 95% CI 1.21-2.16, I2 = 0% and HR 2.86, 95% CI 1.87-4.39, I2 = 26% for CKD stage 3 and ≥ stage 4 respectively). In addition, the development of post-procedural renal dysfunction was independently associated with higher late all-cause mortality (HR = 2.32, 95% CI 1.71-3.15, I2 = 42%) after TEER with MC.
Conclusion: Pre- and post-procedural renal dysfunction is a strong independent predictor of late all-cause mortality following TEER with MC and this should be considered during periprocedural planning for these patients.
Keywords: Acute kidney injury; Chronic kidney disease; MitraClip; Mitral regurgitation; Mitral valve repair; Mortality; Outcome.
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