Prognostic Implications of Acute Renal Failure after Surgery for Type A Acute Aortic Dissection

Abstract

Background: "Type A" acute aortic dissection (AAAD) is the most challenging among the emergency operations in cardiac surgery. The aim of this study was the evaluation of the role of acute renal failure (ARF) in postoperative survival of patients operated for AAAD. Methods: From February 2010 to April 2012, 37 consecutive patients were operated at our department for AAAD. We studied our population by subdividing the patients within groups according to the presence of ARF requiring continuous veno-venous hemofiltration (CVVH) and according to hypothermic circulatory arrest (HCA) times and degrees. Results: The overall 30-day mortality was 27% (50% group A with ARF, 13% group B no ARF). Acute renal failure requiring CVVH was 37.8%. Multivariate analysis revealed a significant association with 30-day mortality (odds ratio 6.6 and p = 0.020). Preoperative oliguria [urine output less than 30 ml/h (odds ratio 4.7 p = 0.039)], CPB greater than 180 minutes (odds ratio 6.5 p = 0.023) and postoperative bleeding requiring a surgical reopening (odds ratio 12.2 and p = 0.021) were the variables significantly associated with acute kidney injury. Conclusions: The data obtained from our analysis bring out the high incidence of renal injuries after surgery for AAAD, and indicate a negative impact on renal injuries of a preoperative oliguria, longer Cardiopulmonary bypass (CBP)/HCA times, and postoperative bleeding requiring a surgical revision. Our data also suggest a better 30-day survival and better renal outcomes in case of shorter HCA and lesser degree of hypothermia.The option of lesser and shorter hypothermia may be very useful, especially for the elderly patients and octogenarians.

Independent risk factors for postoperative AKI and the impact of the AKI on 30-day postoperative outcomes in patients with type A acute aortic dissection: an updated meta-analysis and meta-regression

“…The study selection process is displayed in Figure 1. A total of seven articles met the inclusion criteria (5)(6)(7)(8)(11)(12)(13), and 1,621 patients were included in the current meta-analysis. The risk of bias assessment is presented in Table 1.…”

“…Renal damages can cause medullary ischemia or reperfusion injury (hypothermic circulatory arrest -mediated). Medullary blood flow reduction accompanied with hypoxia may lead to a failure of osmotic gradient regulation (13). Shorter hypothermic circulatory arrest and lesser hypothermia may result in better renal outcome, especially for elderly patients (13).…”

Postoperative acute kidney injury and early and long-term mortality in acute aortic dissection patients

“…Thirty-six articles were further removed after adopting the predefined inclusion and exclusion criteria. Finally, 7 studies [ 4 – 7 , 10 – 12 ] were included in our meta-analysis.…”

“…The sample sizes ranged from 37 to 375, with a total of 1525 AAD patients. Three studies [ 6 , 7 , 10 ] enrolled the type A aortic dissection patients, 1 study [ 5 ] enrolled the complicated type B aortic dissection patients, and other studies [ 4 , 11 , 12 ] included all types of patients. The median/mean age of the patients ranged from 50.3 to 69 years.…”

Biomarkers in the detection of acute renal failure associated with cardiac surgery

“…Cerrahinin tipi, renal hipoperfüzyon için ayrıca risk oluşturmaktadır. Özellikle renal arter üzerinde yapılan ve aortaya kros-klemp konulan vasküler cerrahilerde bu risk artmaktadır [24] .…”