title: Impact of chronic kidney disease on outcomes after percutaneous mitral valve repair with the MitraClip system: insights from the GRASP registry.
abstract: OBJECTIVE
  Our aim was to evaluate the impact of baseline chronic kidney disease (CKD) on clinical outcomes after percutaneous edge-to-edge mitral valve repair (PMVR).
  
  
  RESULTS
  Two hundred and fourteen consecutive patients dichotomised by the presence of baseline CKD (n=113) or no-CKD (n=101) had their clinical outcomes compared up to 12-month follow-up. The primary safety endpoint was the incidence of major adverse events and the primary efficacy endpoint was freedom from death, surgery for MV dysfunction, or grade ≥3+ MR. The primary safety endpoint was demonstrated in 12.4% vs. 2.0% in CKD and no-CKD patients, respectively (p=0.003). The primary efficacy endpoint at 12 months was significantly lower in CKD patients (65.8% vs. 84.2%, respectively, log-rank p=0.005). While MR reduction and NYHA functional class improvement were mostly sustained and equivalent up to 12 months in no-CKD patients, they were impaired in CKD patients. Baseline CKD was an independent predictor of the primary efficacy endpoint (adjusted HR 2.48, 95% CI: 1.29 to 4.79, p=0.006) and calcified leaflet predicted grade ≥3+ MR at 12 months (adjusted HR 6.56, 95% CI: 2.71 to 15.88, p<0.001).
  
  
  CONCLUSIONS
  CKD patients had worse clinical outcomes compared with no-CKD patients post PMVR. CKD was an independent predictor of the primary efficacy endpoint, whereas calcified leaflet was an independent predictor of grade ≥3+ MR at 12 months.
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Ohno
authors.forename: Guilherme F
authors.initials: GF
authors.lastname: Attizzani
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Stefano
authors.initials: S
authors.lastname: Cannata
authors.forename: Fabio
authors.initials: F
authors.lastname: Dipasqua
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Immé
authors.forename: Margherita
authors.initials: M
authors.lastname: Ministeri
authors.forename: Anna
authors.initials: A
authors.lastname: Caggegi
authors.forename: Anna M
authors.initials: AM
authors.lastname: Pistritto
authors.forename: Marta
authors.initials: M
authors.lastname: Chiarandà
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ronsivalle
authors.forename: Sandra
authors.initials: S
authors.lastname: Giaquinta
authors.forename: Sarah
authors.initials: S
authors.lastname: Mangiafico
authors.forename: Salvatore
authors.initials: S
authors.lastname: Scandura
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Carmelo
authors.initials: C
authors.lastname: Grasso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000601:surgery; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome