Renal malperfusion affects operative mortality rather than late death following acute type A aortic dissection repair

Abstract

The aim of our study was to assess how much renal malperfusion increases the risk of early and late mortality in patients with acute type A aortic dissection (ATAAD) undergoing surgical repair. This study included 218 patients with ATAAD undergoing surgical repair using the total arch replacement and frozen elephant trunk technique. Mean age was 47.8±10.7 years and 170 were male (78.0%). Based on clinical symptoms and computed tomographic angiography (CTA) findings, 48 patients were diagnosed with preoperative renal malperfusion (22.0%). Clinical data were compared between two groups. The impact of renal malperfusion on operative and late mortality were evaluated with Cox regression. Patients with renal malperfusion experienced significantly higher incidences of persistent postoperative acute kidney injury (AKI; 10/48, 20.8% vs 7/170, 4.1%; p<0.001) and transient AKI (10/48, 20.8% vs 8/170, 4.7%; p=0.001) as well as operative mortality (22.9%, 11/48 vs 8.3%, 14/170; p=0.023). Five-year survival was significantly lower in the renal malperfusion group (72.9% vs 87.0%, p=0.003). Renal malperfusion was the risk factor for operative mortality (hazard ratio, HR, 2.74; 95% CI, 1.07-6.99; p=0.035) and overall mortality (HR, 2.64; 95% CI, 1.23-5.67; p=0.013) but did not predict late death (HR, 2.46; 95% CI, 0.65-9.35; p=0.187). Renal malperfusion increases the risk of operative mortality by 3 times but did not affect late death in patients undergoing acute type A dissection repair.