Mitral Valve Repair in Patients with Chronic Kidney Disease: Long-Term Outcomes and Cardiac Remodeling

Objectives: Literature examining mitral valve repair (MVr) outcomes in patients with chronic kidney disease (CKD) is largely limited to short-term outcomes and percutaneous approaches. This study is the first to present long-term outcomes of mortality and morbidity with paired cardiac remodeling data from patients with CKD undergoing surgical MVr.

Design: A retrospective, observational, comparative study.

Setting: Single-center university hospital.

Participants: Patients with varying stages of CKD undergoing MVr from 2004 to 2018.

Interventions: Patients were grouped by estimated glomerular filtration (eGFR) rate and followed for a maximum of 15 years. Long-term outcomes and measures of cardiac remodeling were then compared between the groups.

Measurements and main results: The primary outcome was all-cause mortality. Secondary outcomes included measures of postoperative morbidity and cardiac remodeling. Every 10-unit increase in eGFR was associated with a significant reduction in all-cause mortality at 5 years (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.67-0.98, p = 0.028), 10 years (HR: 0.82, 95% CI: 0.72-0.94, p = 0.004), and at 15 years (HR: 0.78, 95% CI: 0.69-0.88, p < 0.001). The moderate CKD group had significantly higher rates of all-cause mortality at 15 years (HR: 3.38, 95% CI: 1.28-8.98, p = 0.014). eGFR was a significant predictor for residual moderate-to-severe mitral regurgitation at 1 year (HR: 0.74, 95% CI: 0.57-0.96, p = 0.024). There was positive cardiac remodeling following MVr in patients with CKD with a significant reduction in left ventricular size and left atrium volume.

Conclusions: In patients with CKD undergoing MVr, eGFR is a predictor of decreased long-term survival and residual mitral regurgitation at 1 year. Further investigation is required to optimize postoperative outcomes in this patient population.