Acute Kidney Injury After Acute Repair of Type A Aortic Dissection

Background. The aim of this study was to examine the incidence, risk factors, and outcomes of patients with acute kidney injury (AKI) after surgery for acute type A aortic dissection (ATAAD) using the Nordic Consortium for Acute Type A Aortic Dissection registry. Methods. Patients who underwent ATAAD surgery at 8 Nordic centers from 2005 to 2014 were analyzed for AKI according to the RIFLE criteria. Patients who died intra-operatively, those who had missing baseline or post-operative serum creatinine, and patients on preoperative renal replacement therapy were excluded. Results. AKI occurred in 382 of 941 patients (40.6%), and postoperative dialysis was required for 105 patients (11.0%). Renal malperfusion was present preoperatively in 42 patients (5.1%), of whom 69.0% developed post-operative AKI. In multivariable analysis patient-related predictors of AKI included age (per 10 years; odds ra -tio [OR], 1.30; 95% confidence interval [CI], 1.15-1.48), body mass index >30 kg/m(2) (OR, 2.16; 95% CI, 1.51-3.09), renal malperfusion (OR, 4.39; 95% CI, 2.23-9.07), and other malperfusion (OR, 2.10; 95% CI, 1.55-2.86). Peri-operative predictors were cardiopulmonary bypass time (per 10 minutes; OR, 1.04; 95% CI, 1.02-1.07) and red blood cell transfusion (OR per transfused unit, 1.08; 95% CI, 1.06-1.10). Rates of 30-day mortality were 17.0% in the AKI group compared with 6.6% in the non-AKI group (P < .001). In 30-day survivors AKI was an inde-pendent predictor of long-term mortality (hazard ratio, 1.86; 95% CI; 1.24-2.79). Conclusions. AKI is a common complication after sur-gery for ATAAD and independently predicts adverse long-term outcome. Of note one-third of patients pre -senting with renal malperfusion did not develop post-operative AKI, possibly because of restoration of renal blood flow with surgical repair. Mortality risk persists beyond the perioperative period, indicating that close clinical follow-up of these patients is required. (C) 2021 by The Society of Thoracic Surgeons

Automated summary

This study examined the occurrence of AKI in patients undergoing surgery for ATAAD in 8 Nordic centers from 2005 to 2014. AKI was found to be a common complication after ATAAD surgery and independently predicted adverse long-term outcomes, emphasizing the importance of close clinical follow-up for these patients.