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 1. Bright R. Cases and observations illustrative of renal disease accompanied with the secretion of albuminous urina. Guy’s Hosp Trans. 1986;1:338–79. 2. Keleş T, Ayhan H, Durmaz T, Sarş C, Aslan AN, Erdoğan KE, et al. Improvement in renal functions with transcatheter aortic valve implantation. J Geriatr Cardiol. 2013;10(4):317–22. 3. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus Surgical Aortic-Valve Replacement inHigh-Risk Patients Craig. N Engl J Med. 2011;364(23):2187–98. 4. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. N Engl J Med. 2010;363(17):1597–607. 5. Florath I, Albert A, Hassanein W, Arnrich B, Rosendahl U, Ennker IC, et al. Current determinants of 30-day and 3-month mortality in over 2000 aortic valve replacements: impact of routine laboratory parameters. Eur J Cardio- thoracic Surg. 2006;30(5):716–21. 6. Anderson RJ, O’Brien M, MaWhinney S, VillaNueva CB, Moritz TE, Sethi GK, et al. Mild renal failure is associatedwith adverse outcome after cardiac valve surgery. Am J Kidney Dis. 2000;35(6):1127–34. 7. Brown JR, Hisey WM, Marshall EJ, Likosky DS, Nichols EL, Everett AD, et al. Acute Kidney Injury Severity and Long-term Readmission and Mortality Following Cardiac Surgery. Ann Thorac Surg. 2016;102(5):1482–9. 8. Elhmidi Y, Bleiziffer S, Deutsch MA, Krane M, Mazzitelli D, Lange R, et al. Acute kidney injury after transcatheter aortic valve implantation: Incidence, predictorsand impactonmortality.ArchCardiovascDis.2014;107(2):133–9. 9. Sinning JM, Ghanem A, Steinhuser H, Adenauer V, Hammerstingl C, Nickenig G, et al. 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National Fundation Kidney, KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Am J Kidney Dis.2012;60(5):850-86. 14. Faillace BLR, Ribeiro HB, Campos CM, Truffa AAM, Bernardi FL, Oliveira MDP, et al. Potential of transcatheter aortic valve replacement to improve post-procedure renal function. Cardiovasc Revascularization Med. 2017;18(7):507–11. 15. Azarbal A, Malenka DJ, Huang Y-L, Ross CS, Solomon RJ, DeVries JT, et al. Recovery of Kidney Disfunction After Transcatheter Aortic Valve Implantation (from theNorthernNewEnglandCardiovascular Disease Study Group). Am J Cardiol. 2018;123(1):426-33. 16. Najjar M, Yerebakan H, Sorabella RA, Guglielmetti L, Vandenberge J, Kurlansky P, et al. Reversibility of chronic kidney disease and outcomes following aortic valve replacement. Interact Cardiovasc Thorac Surg. 2015;21(4):499–505. 17. Levi A, Codner P, Masalha A, GargiuloG, Praz F, Hayashida K, et al. Predictors of 1-Year Mortality After Transcatheter Aortic Valve Implantation in Patients With and Without Advanced Chronic Kidney Disease. Am J Cardiol. 2017;120(11):2025–30. References replacement in these patients; and other important covariates not included in this study (such as the severity of aortic stenosis, intra-procedure events, including hypotension, and AKI after the procedure). Summarizing, the association between worse outcomes in CKD patients undergoing TAVI is well-established, while the potential reversibility of kidney function after aortic valve replacement has not been well-investigated. Despite the limitations, our study provides some significant evidence of reversibility of CKD after aortic valve replacement, probably due to improved renal perfusion post-procedure. Further randomized controlled studies involving more patients and longer follow-up periods are necessary to evaluate the reversibility of CKD after aortic valve replacement. Conclusions Our study suggests that the correction of aortic stenosis is associated with an improvement in kidney function in patients with moderate to severe CKD, showing some significant evidence of reversibility of CKD after aortic valve replacement. The confirmation of this ‘reversibility of CKD’ effect is clinically important insofar as it may help to improve the decision-making process, refining risk stratification in these challenging groups of patients, and perhaps become one of the indications for TAVI. Author contributions Conception and design of the research and Writing of the manuscript: Calça R; Acquisition of data: Calça R, Teles RC, Brito J, Nolasco T, Almeida MD; Analysis and interpretation of the data and Statistical analysis: Calça R, Teles RC, Branco P, Weigert A; Critical revision of the manuscript for intellectual content: Teles RC, Branco P, Gaspar A, Neves JP, Mendes M, Weigert A, Machado DS. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 1110