ABC | Volume 113, Nº6, December 2019

Original Article Calça et al. Aortic valve repair and kidney function Arq Bras Cardiol. 2019; 113(6):1104-1111 Table 2 – Iodine contrast administered to the three groups Iomeron® (n; %) Visipaque® (n; %) p-value Group 1 65; 65.0% 35;35.0% 0.004 Group 2 42; 41.2% 62; 58.8% 0.092 Group 3 20; 64.5% 11; 35.5% 0.151 Table 3 – Evolution of kidney function after TAVI N patients eGFR pre-TAVI (mL/min/1.73 m 2 ) eGFR 1 month after TAVI (mL/min/1.73 m 2 ) eGFR 1 year after TAVI (mL/min/1.73 m 2 ) p-value Group 1 60 74.9 ± 9.0 65.6 ± 20.0 63.4 ± 19.2 <0.001 Group 2 48 45.4 ± 8.5 50.1 ± 15.1 52.6 ± 16.4 0.001 Group 3 17 24.4 ± 5.1 34.9 ± 18.1 38.4 ± 18.8 0.012 All patients 125 56.7 ± 20.5 55.5 ± 20.9 55.8 ± 19.9 0.51 eGFR: estimated glomerular filtration rate; TAVI: transcatheter aortic valve implantation. *p-value between eGFR pre-TAVI and eGFR 1 year after TAVI. Table 4 – Repeated Measures ANOVA: pairwise comparisons (Group 1) (I) eGFR (J) eGFR Mean Difference (I-J) Std. Error Sig. † 95% Confidence Interval for Difference † Lower Bound Upper Bound eGFR pre-TAVI eGFR 1 month after TAVI 9.276* 2.533 0.002 3.034 15.518 eGFR 1 year after TAVI 11.521* 2.612 < 0.001 5.084 17.958 eGFR 1 month after TAVI eGFR pre-TAVI -9.276* 2.533 0.002 -15.518 -3.034 eGFR 1 year after TAVI 2.245 2.072 0.849 -2.861 7.351 eGFR 1 year after TAVI eGFR pre-TAVI -11.521* 2.612 <0.001 -17.95 -5.084 eGFR 1 month after TAVI -2.245 2.072 0.849 -7.351 2.861 *The mean difference is significant at the 0.05 level. † Adjusted for multiple comparisons: Bonferroni. eGFR: estimated glomerular filtration rate; TAVI: transcatheter aortic valve implantation. dysfunction before aortic valve replacement. Azarbal et al. 15 have found similar results. In their work, acute kidney recovery (defined as a positive change in eGFR of ≥ 25% 48 hours after TAVI) was strongly associatedwith baseline CKD: 8.9% in patients with eGFR>60mL/min/1.73m 2 compared to 26.6% in patients with eGFR < 60 mL/min/1.73 m 2 . Also, in a multivariate logistic regression model, lower baseline eGFR was highly predictive of acute kidney recovery (OR 3.27, 95%CI 1.84–5.82, p<0.001). 15 Najjar et al. 16 showed that patients withmoderate and severe CKD (30 ≥ eGFR> 60 and eGFR< 30, respectively) had initial improvement in eGFR, peaking one week after the aortic valve replacement. The improvement was maintained after one year for patients with moderate CKD and after six months in patients with severe CKD compared with the pre‑TAVI eGFR value. The group with severe CKD also presented a better short- and long-term survival in this study. We believe that these results are due to an improvement in cardiac output and a reduction in venous congestion after aortic valve replacement, leading to better kidney perfusion, and therefore an improvement in kidney function. These data suggest that a better kidney function can be expected in patients with CKD G3-5, which may have important implications in the selection of individuals for the treatment of aortic valve diseases. The short- and long-term prognosis of aortic valve replacement in patients with CKD prior to the procedure often calls into question the benefit of valve repair in these patients. Recently, some studies have shown that the poor prognosis associated with CKD is influenced by the stage of the disease. 5,6,15,16 Gibson and his work group 19 revealed that eGFR < 60 mL/min/1.73 m 2 is an important predictor of mortality post-TAVI (HR 5.0, 95%CI 1.87–13.4, p = 0.001) as well as in short-term follow-up (HR 2.98, 95%CI 1.85–4.80, p < 0.001). Other recent study 20 shows that for patients with eGFR < 60 mL/min/1.73 m 2 , a variation as small as 5mL/min/1.73m 2 in eGFR couldmake a measurable difference in risk of death, RRT, or both at 30 days and 1 year of follow-up. Nguyen et al. 21 showed that a worsening in renal function was associated with increased in-hospital mortality, hospital length of stay, and intensive care unit length of stay in surgical aortic valve replacement patients, but not in TAVI patients. Our study contradicts these data. We found no difference in mortality among patients with CKD G3-5 compared to those who had CKD G1-2 or no CKD before TAVI. 1107