Acute Kidney Injury After Percutaneous Edge-to-Edge Mitral Repair

Armijo, Germán; Estévez‐Loureiro, Rodrigo; Carrasco-Chinchilla, Fernando; Arzamendi, Dabit; Fernández‐Vázquez, Felipe; Jimenez-Quevedo, Pilar; Freixa, Xavier; Pascual, Isaac; Serrador, Ana; Mesa, Dolores; Alonso‐Briales, Juan H.; Goicolea, Javier; Hernández‐Antolín, Rosana; Fernández-Peregrina, Estefanía; Álvarez, Ana Belén Cid; Andraka, Leire; Cruz-González, Ignacio; Berenguer, Alberto; Sanchis, Juan; Díez-Gil, José Luis; Hernández-García, José M.; Li, Chi-Hion; Benito‐González, Tomas; Agustin, José Alberto de; Avanzas, Pablo; Regueiro, Ander; Amat‐Santos, Ignacio J.; Pan, Manuel; Nombela‐Franco, Luis

doi:10.1016/j.jacc.2020.09.582

Cited by 25 publications

(25 citation statements)

References 36 publications

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“…HF, CKD, anemia, and DM are known risk factors for AKI in patients undergoing other catheter-based procedures such as PCI, TAVR, and TMVr. [1][2][3]16 Similar to our study, CKD has also been identified as a predictor of AKI following LAAC in a prior study. 11 LAAC typically requires a small volume of contrast material to visualize the left atrial appendage, which may increase the risk of AKI especially in patients with baseline CKD.…”

Section: Association Between Aki and Outcomes Following Laacsupporting

confidence: 88%

“…AKI portends a worse short-and long-term survival in patients undergoing PCI, TAVR, and TMVr. [1][2][3][4] Our results extend these findings to LAAC, demonstrating a higher risk of in-hospital mortality and other procedural complications. Even though LAAC patients with AKI had higher comorbidities that could lead to residual confounding, the ~16-fold increased odds of in-hospital mortality after multivariable adjustment suggest that AKI independently contributes to mortality, possibly due to activation of immunological, neurohormonal, and inflammatory pathways.…”

Section: Association Between Aki and Outcomes Following Laacsupporting

confidence: 81%

“…Non-elective procedures were associated with an increased risk of AKI in our study, similar to prior reports in patients undergoing other invasive vascular procedures. [1][2][3]16,20 In summary, baseline renal function should be carefully monitored in patients undergoing LAAC, particularly those with CKD, DM, anemia, and HF. Furthermore, universal nephroprotective strategies employed with other invasive vascular procedures such as minimizing bleeding, peri-procedural hypotension, catheter manipulation, and contrast media administration should be utilized in patients undergoing LAAC to reduce the risk of AKI.…”

Section: Association Between Aki and Outcomes Following Laacmentioning

confidence: 99%

“…Acute kidney injury (AKI) is independently associated with increased morbidity and mortality following percutaneous coronary interventions (PCI), transcatheter aortic valve replacement (TAVR), and transcatheter mitral valve repair (TMVr). [1][2][3][4] Percutaneous left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific, Marlborough, MA) was approved in March 2015 in the United States for reducing thromboembolic risk in patients with nonvalvular atrial fibrillation (AF) who are poor candidates for long-term anticoagulation. [5][6][7][8] In real-world clinical practice, patients selected for LAAC procedures are older, have a higher burden of comorbid conditions (diabetes mellitus, heart failure, chronic kidney disease), and have elevated bleeding risk compared with patients enrolled in pivotal randomized controlled trials, 9 factors that are well-known to be associated with AKI.…”

Section: Introductionmentioning

confidence: 99%

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Association of acute kidney injury with outcomes in patients undergoing percutaneous left atrial appendage closure

Nazir

Ahuja

Ariss

et al. 2021

Cathet Cardio Intervent

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Objectives: Using a large nationally representative database, we aimed to examine risk factors for acute kidney injury (AKI) and its association with outcomes in patients undergoing percutaneous left atrial appendage closure (LAAC).Background: Previous small-scale studies have reported poor outcomes with AKI following percutaneous LAAC. Methods:We queried the Nationwide Readmission Database to identify LAAC procedures performed from 2016 to 2017. Multivariable logistic and linear regression models were used to identify risk factors for AKI and determine the association between AKI and clinical outcomes. The primary outcome of interest was in-hospital mortality.Results: Of 20,703 patients who underwent LAAC during the study period, 1,097(5.3%) had a diagnosis of AKI. Chronic kidney disease, non-elective admission, coagulopathy, weight loss, prior coronary artery disease, heart failure, diabetes mellitus, and anemia were independently associated with an increased risk of AKI after LACC. In patients undergoing LAAC, AKI was associated with an increased risk of in-hospital mortality (adjusted odds ratio [aOR], 16.01; 95% CI,

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Section: Association Between Aki and Outcomes Following Laacsupporting

confidence: 88%

Section: Association Between Aki and Outcomes Following Laacsupporting

confidence: 81%

Section: Association Between Aki and Outcomes Following Laacmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association of acute kidney injury with outcomes in patients undergoing percutaneous left atrial appendage closure

Nazir

Ahuja

Ariss

et al. 2021

Cathet Cardio Intervent

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“…The number of percutaneous edge‐to‐edge mitral valve repair procedures has increased in the last decade, mainly being used to treat high‐risk patients with degenerative and functional chronic MR 53,54 . Operator experience, improvement in valve visualization and a better understanding of the MR etiology have allowed expansion of the indication for edge‐to‐edge repair procedures beyond those of the original Everest criteria 1 .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review

Martínez-Gómez

McInerney

Tirado‐Conte

et al. 2021

Catheter Cardiovasc Interv

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Background Very few data exist on percutaneous mitral valve repair (PMVr) in unstable patients with concomitant moderate–severe mitral regurgitation (MR). The purpose of this systematic review was to evaluate baseline characteristics, management and clinical outcomes of critically ill patients undergoing PMVr with MitraClip. Methods We conducted a systematic review of the published data on MitraClip from its first use in 2003 to December 2020. Studies referring to critically ill patients in cardiogenic shock or acute refractory pulmonary edema were included. A total of 40 publications including 254 patients with significant MR (Grade 4 in 91%) were included. Results Mean age was 70 ± 12 years with mean Euroscore II and STS of 21 ± 13 and 20.5 ± 16, respectively. Clinical presentation was with cardiogenic shock and acute myocardial infarction in 72.8 and 60.0% of patients, respectively. Device success was achieved in 238 (93.7%) patients with a significant reduction in MR (Grade ≤ 2 in 91.8%, p < .001). The median weaning time from the procedure, to discontinuation of mechanical circulatory or respiratory support, was 2 days (IQR 1–4), with an in‐hospital mortality and non‐fatal complication rate of 12.6 and 9.1%, respectively. Kaplan–Meier curves estimated an overall mortality rate of 39.1% at 12‐month follow‐up, with persistent reduction in MR severity for survivors (Grade ≤ 2 in 81.3%) and one case of mitral valve reintervention. Conclusions Percutaneous mitral valve repair with MitraClip device is a technically feasible and potentially viable management option in high‐risk patients with cardiogenic shock or refractory pulmonary edema and concomitant moderate–severe MR. Prospective trials are required to confirm these findings, and definitively determine the value of MitraClip in hemodynamically unstable patients.

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Aktuelles zur Herz-Nieren-Interaktion

Emrich

Tokcan

Ghorani

et al. 2021

Herz

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ZusammenfassungChronisch nierenkranke Patienten weisen eine erhöhte kardiovaskuläre Morbidität und Sterblichkeit auf. Im letzten Jahr sind einige wichtige Studien zur Herz-Nieren-Interaktion veröffentlicht worden, die im Folgenden zusammengefasst und diskutiert werden. In der DAPA-CKD-Studie sowie in der SCORED-Studie konnten 2 unterschiedliche SGLT2(„sodium-glucose linked transporter 2“)-Inhibitoren (Dapagliflozin und Sotagliflozin) die Prognose von chronisch nierenkranken Patienten mit und ohne Diabetes nachweislich verbessern. Auch die Ergebnisse der randomisierten Studie zum neuen Mineralokortikoidrezeptorantagonisten Finerenon – FIDELIO-DKD – liefern einen vielversprechenden neuen Therapieansatz für Patienten mit diabetischer Nephropathie. Die veröffentlichten Daten der ISCHEMIA-CKD-Studie bei Patienten mit koronarer Herzkrankheit und Untersuchungen zum Einfluss einer TAVI („transcatheter aortic valve implantation“) auf die Nierenfunktion sowie eine weitere Studie zum akuten Nierenversagen nach MitraClip®-Implantation (Abbott, Chicago, IL, USA) geben wichtige Hinweise zu zukünftigen Handlungsempfehlungen. Der optimale Zeitpunkt der Einleitung einer Nierenersatztherapie bei Patienten mit akuter Nierenschädigung in der Intensivmedizin wurde in 2 randomisierten Studien untersucht, die entsprechend diskutiert werden.

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Acute Kidney Injury After Percutaneous Edge-to-Edge Mitral Repair

Cited by 25 publications

References 36 publications

Association of acute kidney injury with outcomes in patients undergoing percutaneous left atrial appendage closure

Association of acute kidney injury with outcomes in patients undergoing percutaneous left atrial appendage closure

Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review

Aktuelles zur Herz-Nieren-Interaktion

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