Transcatheter compared with surgical mitral valve intervention in patients with end-stage renal disease.

Abstract

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. 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. 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). 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.