Key result
Transcatheter mitral valve replacement/repair did not significantly alter the odds of in-hospital mortality compared to surgery in patients with end-stage renal disease (aOR 1.70; 95% CI 0.96-2.99).
Why the study?
Patients with end-stage renal disease are at increased risk for mitral valve calcification and dysfunction, motivating an evaluation of clinical and financial outcomes comparing transcatheter versus surgical mitral valve intervention.
Does transcatheter mitral valve replacement/repair improve clinical outcomes and reduce complications compared to surgical mitral valve replacement/repair in patients with end-stage renal disease?
Cohort (n=3,782)
Yes
Does transcatheter mitral valve replacement/repair improve clinical outcomes and reduce complications compared to surgical mitral valve replacement/repair in patients with end-stage renal disease?
Odds Ratio: 1.7 (95% CI 0.96–2.99)
In patients with end-stage renal disease, transcatheter mitral valve intervention offers similar short-term mortality and readmission rates to surgery, but with a more favorable safety profile and improved discharge outcomes.
May support transcatheter mitral intervention for fewer complications in end-stage renal disease; leaves open confirmation of mortality equivalence in randomized trials.
INTRODUCTION: Patients with end-stage renal disease are at increased risk for developing mitral valve calcification and dysfunction. The present study evaluated clinical and financial outcomes of transcatheter compared with surgical mitral valve replacement/repair in patients with end-stage renal disease using a national cohort. METHODS: This was a retrospective analysis of all adult patients with end-stage renal disease receiving isolated surgical mitral valve replacement/repair or transcatheter mitral valve replacement/repair in the Nationwide Readmissions Database (2016-2021). Outcomes included in-hospital mortality, 30-day nonelective readmissions, complications, hospitalization costs, length of stay, and nonhome discharge. Entropy balancing and multivariable regressions adjusted for intergroup differences, with results reported as adjusted odds ratios and 95% confidence intervals. RESULTS: Among 3,782 patients with end-stage renal disease, 12.8% underwent transcatheter mitral valve replacement/repair, with use significantly increasing from 49 cases in 2016 to 122 cases in 2021 (NPTrend < 0.001). Patients undergoing transcatheter mitral valve replacement/repair were older (70 vs 58 years, P < .001) and had greater rates of atrial fibrillation (57.8 vs 46.8%, P < .001) and mitral stenosis (21.7 vs 8.6%, P < .001). After entropy balancing and risk adjustment (with surgical mitral valve replacement/repair as reference), transcatheter mitral valve replacement/repair did not alter the odds of in-hospital mortality (adjusted odds ratio, 1.70; confidence interval, 0.96-2.99), 30-day readmissions (adjusted odds ratio, 0.99; confidence interval, 0.62-1.59), or hospitalization costs (β -$4.4K, confidence interval, -$20.3K to $11.6K). Transcatheter mitral valve replacement/repair was associated with reduced odds of blood transfusion (adjusted odds ratio, 0.45; confidence interval, 0.29-0.72), infectious (adjusted odds ratio; 0.53, confidence interval, 0.32-0.88) and respiratory (adjusted odds ratio, 0.34; confidence interval, 0.24-0.47) complications, and non-home discharge (adjusted odds ratio; 0.29, confidence interval, 0.17-0.50). CONCLUSION: In conclusion, our study underscores the evolving landscape of mitral valve interventions, highlighting the complementary roles of surgical mitral valve replacement/repair and transcatheter mitral valve replacement/repair. The increasing adoption of transcatheter mitral valve replacement/repair reflects its favorable safety profile and improved discharge outcomes, particularly in elderly and high-risk patients. Future research should focus on further evaluating long-term outcomes and exploring strategies to enhance the cost-effectiveness and accessibility of both interventions.
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Aguayo et al. (2025) conducted a cohort in End-stage renal disease requiring mitral valve intervention (n=3,782). Transcatheter mitral valve replacement/repair vs. Surgical mitral valve replacement/repair was evaluated on In-hospital mortality (aOR 1.70, 95% CI 0.96-2.99). Transcatheter mitral valve replacement/repair did not significantly alter the odds of in-hospital mortality compared to surgery in patients with end-stage renal disease (aOR 1.70; 95% CI 0.96-2.99).
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