Transcatheter Mitral Valve Implantation In Patients With Chronic Kidney Disease.

There is a paucity of data regarding the outcomes of trans-septal transcatheter mitral valve implantation (TS-TMVI) in patients with chronic kidney disease (CKD). We queried the Nationwide Readmissions Database (2015 to 2018) for patients undergoing TS-TMVI. We identified patients with CKD (Stage III or higher). We conducted propensity score matching analysis to compare the outcomes in patients with CKD versus patients without CKD. The main outcomes were in-hospital mortality and 30-day nonelective readmissions. From 2015 to 2018, there were 2,017 admissions for patients receiving TS-TMVI, of whom 733 (36.34%) had CKD. In the CKD group, 76 (10.4%) required chronic dialysis. During the study years, the number of TS-TMVI procedures increased in patients with CKD (ptrend <0.001). Patients with CKD were older and less likely to be women. There was no difference in in-hospital mortality in those with versus without CKD in the matched cohorts (7.8% vs 7.3%; odds ratio 1.09; 95% confidence interval 0.64 to 1.80). Subgroup analysis showed no interaction between chronic dialysis status and in-hospital mortality after TS-TMVI. In the matched cohort, TS-TMVI in those with CKD was associated with higher rates of cardiogenic shock (12.3% vs 7.6%, p = 0.03), acute kidney injury (35.7% vs 16.7%, p <0.001), hemodialysis (5.4% vs 1.5%, p = 0.01) and longer median length of stay, (7 [12] vs 5 [8] days, p <0.001). Patients with CKD were more likely to have 30-day nonelective readmission (25.8% vs 16.5%, p = 0.01), driven by more readmissions for bleeding/anemia. In conclusion, TS-TMVI in patients with CKD is associated with increased risk for cardiogenic shock, worsening renal function requiring hemodialysis, without increased risk of mortality when compared with patients without CKD. Also, there was a higher length of stay and 30-day readmission rate in patients with CKD versus patients without CKD.

Targeted Hypothermia vs Targeted Normothermia in Survivors of Cardiac Arrest: A Systematic Review and Meta-Analysis of Randomized Trials.

BACKGROUND: The role of targeted hypothermia in patients with coma after cardiac arrest has been challenged in a recent randomized clinical trial. METHODS: We performed a computerized search of MEDLINE, EMBASE, and Cochrane databases through July 2021 for randomized trials evaluating the outcomes of targeted hypothermia vs normothermia in patients with coma after cardiac arrest with shockable or non-shockable rhythm. The main study outcome was mortality at the longest reported follow-up. RESULTS: The final analysis included 8 randomized studies with a total of 2927 patients, with a weighted follow-up period of 4.9 months. The average targeted temperature in the hypothermia arm in the included trials varied from 31.7°C to 34°C. There was no difference in long-term mortality between the hypothermia and normothermia groups (56.2% vs 56.9%, risk ratio [RR] 0.96; 95% confidence interval [CI], 0.87-1.06). There was no significant difference between hypothermia and normothermia groups in rates of favorable neurological outcome (37.9% vs 34.2%, RR 1.31; 95% CI, 0.99-1.73), in-hospital mortality (RR 0.88; 95% CI, 0.77-1.01), bleeding, sepsis, or pneumonia. Ventricular arrhythmias were more common among the hypothermia vs normothermia groups (RR 1.36; 95% CI, 1.17-1.58; P = .42). Sensitivity analysis, excluding the Targeted Hypothermia vs Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial, showed favorable neurological outcome with hypothermia vs normothermia (RR 1.45; 95% CI, 1.17-1.79). CONCLUSION: Targeted temperature management was not associated with improved survival or neurological outcomes compared with normothermia in comatose patients after cardiac arrest. Further studies are warranted to further clarify the value of targeted hypothermia compared with targeted normothermia.