Patients Who Develop AKI After TEER for Tricuspid Regurgitation Have Poorer Outcomes

Acute kidney injury (AKI) occurs among 15.7% of patients who receive transcatheter edge-to-edge repair (TEER) for tricuspid regurgitation (TR). These findings were published in JACC: Cardiovascular Interventions.

Data for this retrospective analysis were sourced from University Hospital Bonn and University Hospital Düsseldorf in Germany. Patients (N=268) who received tricuspid TEER with the MitraClip/TriClip or PASCAL systems between 2015 and 2021 were evaluated for 1-year outcomes on the basis of AKI.

The study population comprised patients with a mean age of 79.0 [SD, 6.8] years, 43.3% were men, BMI was 25.8 [SD, 5.0], estimated glomerular filtration rate (eGFR) was 50.4 [SD, 23.1] mL/min/1.73 m², 82.8% had hypertension, and 25.0% had diabetes. A total of 42 patients developed AKI. Patients with AKI were more male (P =.003), had higher European System for Cardiac Operative Risk Evaluation II score (P =.003), and were older (P =.012) compared with the patients who did not have AKI.

Overall, 88.4% of patients had procedural success and 94.4% technical success. Fewer patients who developed AKI had procedural (78.6% vs 90.3%; P =.038) and technical (85.7% vs 96.0%; P =.008) success compared with the non-AKI cohort, respectively. No other procedural data differed on the basis of AKI.

The in-hospital mortality rate was 2.2% and was significantly higher among the AKI cohort (9.5%) compared with the non-AKI group (0.9%; P =.006). The AKI group was also associated with higher rates of major or life-threatening bleeds (9.5% vs 2.2%; P =.037) and longer hospital stays (median, 8 vs 7 days; P =.041) compared with the non-AKI group, respectively. Rates of the composite outcome of all-cause mortality and hospitalization for heart failure were higher for patients with AKI at 30 days (P =.004) and 1 year (P <.001).

Risk for AKI was associated with male gender (odds ratio [OR], 3.12; 95% CI, 1.53-6.40; P =.002), eGFR below 60 mL/min/1.73 m² (OR, 2.75; 95% CI, 1.06-7.14; P=.037), lack of procedural success (OR, 2.54; 95% CI, 1.01-6.38; P =.046), and age (OR, 1.07; 95% CI, 1.00-1.14; P =.036).

Risk for all-cause mortality and heart failure hospitalization was associated with AKI (hazard ratio [HR], 2.39; 95% CI, 1.45-3.94; P =.001), chronic obstructive pulmonary disease (HR, 1.67; 95% CI, 1.02-2.74; P =.041), and left ventricular ejection fraction per 10% (HR, 0.69; 95% CI, 0.56-0.85; P <.001).

In a subgroup analysis, no significant interactions were observed for the relationship between AKI and the composite outcome of all-cause mortality and hospitalization for heart failure.

The results may not be generalizable to patients with advanced tricuspid regurgitation and right ventricular dysfunction, as the majority of patients in this study have preserved right ventricular function.

“Postprocedural AKI was associated with a higher incidence of the composite outcome, consisting of all-cause mortality and rehospitalization for worsening heart failure, within 1 year after the procedure,” the study authors wrote. “Our findings highlight the clinical impact of AKI following TEER for TR and should assist in identifying patients at high risk for AKI.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.