title: Effect of advanced chronic kidney disease in clinical and echocardiographic outcomes of patients treated with MitraClip system.
abstract: BACKGROUND
  Data regarding the influence of different levels of renal dysfunction on clinical and echocardiographic results of MitraClip therapy are scarce. We aimed to evaluate the impact of baseline advance renal failure in the outcomes of a cohort of patients treated with MitraClip.
  
  
  RESULTS
  We analyzed data from a multicenter registry of 173 patients treated with MitraClip between 2009 and 2012. Patients were classified as advanced chronic kidney disease (CKD, creatinine clearance [CrCl] <30 ml/min, group 1, n=20), moderate CKD (CrCl 30-60 ml/min, group 2, n=78) and normal renal function (CrCl >60 ml/min, group 3, n=75). Twenty patients (11.5%) presented advanced CKD. Procedural success was equal in the 3 groups (95.0% group 1, 100% in group 2 and 96.0% in group 3, p=0.180). Post-procedural MR and NYHA class at 1 month (MR ≥ 3+5.0% vs. 0% vs. 4.0% p=0.190 and NYHA>II 40.0% vs. 21.0% vs. 18.3%, p=0.101) and 6 months (MR ≥ 3+0% vs. 13.0% vs. 2.7%, p=0.330; and NYHA class>II 54.5% vs. 26.9% vs. 25.6%, p=0.298) did not differ between groups. However, patients in group 1 experienced higher frequency of the composite end-point of mortality or readmission at 16.2 ± 11.1 months of follow-up (HR 4.8, CI 95% 1.1-21.3).
  
  
  CONCLUSIONS
  Advanced CKD is linked to an excess of cardiac adverse events. This should be judiciously taken into account when selecting patients for MitraClip.
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom. Electronic address: roiestevez@hotmail.com.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Estévez-Loureiro
authors.affiliation: Unit for Interventional Cardiology, Department of Cardiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Settergren
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Michele
authors.initials: M
authors.lastname: Pighi
authors.affiliation: Unit for Interventional Cardiology, Department of Cardiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Reidar
authors.initials: R
authors.lastname: Winter
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Gianni
authors.initials: G
authors.lastname: D'Allara
authors.affiliation: Unit for Interventional Cardiology, Department of Cardiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Jacobsen
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Sondergaard
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Gary
authors.initials: G
authors.lastname: Cheung
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ghione
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Ihlemann
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Moat
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Susanna
authors.initials: S
authors.lastname: Price
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Tine Streit
authors.initials: TS
authors.lastname: Rosenberg
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Olaf
authors.initials: O
authors.lastname: Franzen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D013525:Surgical Instruments; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Catheter-based therapy; Chronic kidney disease; Mitral regurgitation