Surgical and early outcomes for Type A aortic dissection with preoperative renal dysfunction stratified by estimated glomerular filtration rate.

OBJECTIVES

The aim of this study was to analyse the effect of preoperative renal dysfunction on surgical and early outcomes for patients with Type A aortic dissection (AAD).

METHODS

From January 2016 to December 2016, 140 patients with AAD who underwent surgical treatment at our institution were retrospectively analysed. According to the estimated glomerular filtration rate (eGFR), preoperative renal dysfunction was divided into 4 groups: normal (eGFR ≥90 ml/min/1.73 m2, n = 76), mild (eGFR 60-89, n = 40), moderate (eGFR 30-59, n = 20) and severe (eGFR <30, n = 4).

RESULTS

Major complications included prolonged ventilation requiring tracheotomy in 15 patients, renal replacement therapy (RRT) in 28 patients, stroke in 11 patients and paraplegia in 4 patients. The best cut-off value of the eGFR for predicting postoperative RRT was 70 ml/min/1.73 m2 (area under the receiver operating characteristic curve was 0.809). In-hospital mortality was 9.3% (6.5% in the normal group, 5% in the mild group, 20% in the moderate group and 50% in the severe group). Logistic regression analysis showed that age >60 years, moderate and severe renal dysfunction, coronary malperfusion and peripheral malperfusion were risk factors for in-hospital death.

CONCLUSIONS

Total arch replacement can be safely performed in patients with AAD and preoperative mild renal dysfunction. Preoperative renal dysfunction is a risk factor for postoperative RRT, and eGFR is useful for predicting the requirement for postoperative RRT. Our surgical strategy for total arch replacement and stented elephant trunk for patients with AAD and mild preoperative renal dysfunction has excellent early outcomes.