Patients with CKD/ESRD undergoing TTVR had a significantly higher rate of new pacemaker implantation at 29.2% compared to 11.6% in patients without CKD/ESRD (P = .04).
Does transcatheter tricuspid valve replacement (TTVR) provide similar clinical and functional outcomes in patients with chronic kidney disease (CKD)/end-stage renal disease (ESRD) compared to those without CKD/ESRD?
TTVR provides comparable functional improvement and TR reduction in patients with and without CKD/ESRD, but those with CKD/ESRD have a significantly higher risk of requiring a new permanent pacemaker.
Absolute Event Rate: 0% vs 0%
Background: Patients with chronic kidney disease (CKD), including end-stage renal disease (ESRD), undergoing transcatheter tricuspid valve replacement (TTVR) may be at increased risk of adverse outcomes.We compared clinical outcomes after TTVR in patients with versus without CKD/ESRD. Methods:We analyzed 145 patients who underwent TTVR for tricuspid regurgitation (TR).Patients were stratified into 2 cohorts: CKD/ESRD (dialysis dependence and/or estimated glomerular filtration rate <30 mL/min/1.73m 2 ; n = 24) and no CKD/ESRD (n = 121).Baseline characteristics and clinical outcomes were compared.Results: Patients with CKD/ESRD were slightly younger (76.3 years IQR, 69.2-78.6vs 80.8 years IQR, 73.4-85.0;P = .48)and had higher body mass index (29.7 kg/m 2 IQR, 24.2-32.2vs 26.8 kg/m 2 IQR, 23.2-31.0;P = .19),with significantly higher Society of Thoracic Surgeons scores (20.8 vs 12.1; P = .002)and right ventricle systolic pressure (47.5 vs 36.0 mm Hg; P < .001).Baseline New York Heart Association functional class III/IV and TR severity were similar between groups.At 30-day follow-up, all-cause mortality was numerically higher in the CKD/ESRD group (8.3% vs 3.3%; P = .25).Residual TR reduction was achieved in 100% of patients in CKD/ESRD group and 97.6% of patients in the non-CKD/ESRD group (P = .99).Functional outcomes were comparable overall; New York Heart Association functional class III/IV persisted in 25.0% vs 19.3% (P = .73)and median Kansas City Cardiomyopathy Questionnaire-Overall Summary scores were similar (45.8 vs 50.5;P = .57).Major bleeding occurred at similar rates between groups (12.5% vs 12.4%; P = .10),whereas new pacemaker implantation was significantly more common in the CKD/ESRD group (29.2% vs 11.6%; P = .04).Conclusions: TTVR in patients with CKD/ESRD provides comparable functional improvement to that in patients without CKD.However, the patients with CKD/ESRD group have a significantly higher rate of pacemaker implantation, highlighting the need for individualized risk assessment and careful clinical management in this population.
Razmjou et al. (Sun,) reported a other. Patients with CKD/ESRD undergoing TTVR had a significantly higher rate of new pacemaker implantation at 29.2% compared to 11.6% in patients without CKD/ESRD (P = .04).