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ACUTE KIDNEY INJURY FOLLOWING MITRACLIP IMPLANTATION: INCIDENCE, PREDICTS FACTORS AND PROGNOSTIC VALUE
E1752 JACC March 12, 2013 Volume 61, Issue 10
TCT@ACC-i2: Invasive and Interventional Cardiology Acute Kidney Injury following Mitraclip Implantation: Incidence, Predictive Factors and Prognostic Value Oral Contributions West, Room 2022 Sunday, March 10, 2013, 8:45 a.m.-8:55 a.m.
Session Title: Structural Heart Disease (Non-TAVR) Abstract Category: 50. TCT@ACC-i2: Mitral ValveDisease Presentation Number: 2906-7 Authors: Maurizio Taramasso, Azeem Latib, Paolo Denti, Alessandro Candreva, Nicola Buzzatti, Francesco Giannini, Giovanni La Canna, Ottavio Alfieri, Antonio Colombo, Francesco Maisano, San Raffaele University Hospital, Milan, Italy Background: Limited data exist on the occurrence of acute kidney injury (AKI) associated with MitraClip implantation. The objective of the present study is to determine the incidence, predictive factors and prognostic value of AKI following MitraClip treatment in high-risk surgical patients. Methods: From October 2008 to July 2012, 126 consecutive patients with degenerative and functional MR underwent MitraClip implantation in our Institution. All the patients were assessed by a dedicated Heart Team according to a preoperative standardized protocol, which included TEE, coronary angiography and evaluation of the risk profile. The occurrence of AKI was defined as an increase in serum creatinine of 150-200% or ≥0.3 mg/dL up to 72 hours after the procedure or the need for haemodialysis during index hospitalization. RResults: AKI occurred in 33 patients (26.1%). Patients with AKI had higher baseline pro-BNP levels (p=0.02), higher serum creatinine (p=0.01), higher expected 1-year mortality with the 3C-HF score (p=0.005), more frequently functional MR as etiology (p=0.01), and lower EF (p=0.04). In the AKI group, in-hospital mortality was 9.1% versus none no-AKI group (p=0.003). AKI patients required more frequently blood transfusions (p<0.0001), had a higher incidence of perioperative need for IABP (p<0.0001), major infection or sepsis (p=0.0002) and longer median LOS (p5100 pg/ml (OR 5.4), perioperative blood transfusion (OR 9.2) and need for IABP (OR 17.9 ) were identified as independent predictors of AKI. Actuarial survival at 1.5 year was 63.2+/-10.5% in AKI group and 90.9+/-3.1% the No-AKI group (p=0.001). Occurrence of postoperative AKI was identified as an independent predictor of mortality at follow-up (HR 4.1). Conclusions: Acute kidney injury occurred in 26.1% of the patients following MitraClip implantation and was associated with increased risk of in-hospital and 1.5 year mortality. Pro-BNP>5100 pg/ml, perioperative blood transfusion and need for IABP were predictive factors of AKI after MitraClip.
TCT@ACC-i2: Invasive and Interventional Cardiology Acute Kidney Injury following Mitraclip Implantation: Incidence, Predictive Factors and Prognostic Value Oral Contributions West, Room 2022 Sunday, March 10, 2013, 8:45 a.m.-8:55 a.m.
Session Title: Structural Heart Disease (Non-TAVR) Abstract Category: 50. TCT@ACC-i2: Mitral ValveDisease Presentation Number: 2906-7 Authors: Maurizio Taramasso, Azeem Latib, Paolo Denti, Alessandro Candreva, Nicola Buzzatti, Francesco Giannini, Giovanni La Canna, Ottavio Alfieri, Antonio Colombo, Francesco Maisano, San Raffaele University Hospital, Milan, Italy Background: Limited data exist on the occurrence of acute kidney injury (AKI) associated with MitraClip implantation. The objective of the present study is to determine the incidence, predictive factors and prognostic value of AKI following MitraClip treatment in high-risk surgical patients. Methods: From October 2008 to July 2012, 126 consecutive patients with degenerative and functional MR underwent MitraClip implantation in our Institution. All the patients were assessed by a dedicated Heart Team according to a preoperative standardized protocol, which included TEE, coronary angiography and evaluation of the risk profile. The occurrence of AKI was defined as an increase in serum creatinine of 150-200% or ≥0.3 mg/dL up to 72 hours after the procedure or the need for haemodialysis during index hospitalization. RResults: AKI occurred in 33 patients (26.1%). Patients with AKI had higher baseline pro-BNP levels (p=0.02), higher serum creatinine (p=0.01), higher expected 1-year mortality with the 3C-HF score (p=0.005), more frequently functional MR as etiology (p=0.01), and lower EF (p=0.04). In the AKI group, in-hospital mortality was 9.1% versus none no-AKI group (p=0.003). AKI patients required more frequently blood transfusions (p<0.0001), had a higher incidence of perioperative need for IABP (p<0.0001), major infection or sepsis (p=0.0002) and longer median LOS (p5100 pg/ml (OR 5.4), perioperative blood transfusion (OR 9.2) and need for IABP (OR 17.9 ) were identified as independent predictors of AKI. Actuarial survival at 1.5 year was 63.2+/-10.5% in AKI group and 90.9+/-3.1% the No-AKI group (p=0.001). Occurrence of postoperative AKI was identified as an independent predictor of mortality at follow-up (HR 4.1). Conclusions: Acute kidney injury occurred in 26.1% of the patients following MitraClip implantation and was associated with increased risk of in-hospital and 1.5 year mortality. Pro-BNP>5100 pg/ml, perioperative blood transfusion and need for IABP were predictive factors of AKI after MitraClip.