Abstract 14007: Transcatheter Mitral Valve Replacement Among Patients With Chronic Kidney Disease: Insights From The National Readmissions Database

Abstract

Introduction: There is a paucity of data regarding the outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR) among patients with chronic kidney disease (CKD). Methods: We queried the Nationwide Readmissions Database (2015-2018) for patients undergoing TS-TMVR. We identified patients with CKD (stages III or more). We conducted propensity score matching analysis to compare the outcomes of patients with versus without CKD. The main outcomes were in-hospital mortality and 30-day non-elective readmissions. Results: From 2015 to 2018, there were 2,017 discharge records for patients receiving TS-TMVR, of whom 733 (36.34%) had CKD. Among the CKD group, 76 (10.4%) required chronic dialysis. During the study time period, there was an increase in the uptake of TS-TMVR among patients with CKD (p<0.001). Patients with CKD were older (73.311.1 vs. 71.213.2 years, p<0.001), less likely to be women and more likely to have chronic heart failure, CAD and prior CABG. There was no difference in in-hospital mortality after TS-TMVR among those with versus without CKD in the matched cohorts (7.8% vs. 7.3%; OR 1.09; 95% CI: 0.64-1.80, p=0.78). Subgroup analysis showed no interaction between chronic dialysis status and in-hospital mortality after TS-TMVR. In the matched cohort, TS-TMVR among those with CKD was associated with higher rates of cardiogenic shock (12.3% vs. 7.6%, p=0.03), AKI (35.7% vs. 16.7%, p<0.001), and new requirement for hemodialysis (5.4% vs. 1.5%, p=0.01) and longer median length of stay, (7[12] vs. 5 [8] days, p<0.001). Patients with CKD were more likely to have 30-day non-elective readmissions (25.8% vs. 16.5%, p = 0.01), driven by more readmissions for bleeding/ anemia. Conclusions: TS-TMVR among patients with CKD is associated with increased risk for cardiogenic shock, worsening renal function requiring hemodialysis, but no increase in mortality when compared with non-CKD patients. A higher length of stay and 30-day readmission rate was observed in CKD patients versus non-CKD patients.