Acute kidney injury (AKI) after acute Stanford type A aortic dissection (STAAD) surgery
has a high mortality rate. Clarifying what type of renal artery problem (dynamic obstructive
renal artery, DORA, or static obstructive renal artery, SORA) secondary to STAAD benefits
from true lumen opening is helpful in providing a reference for the indication of
renal artery intervention.
From May 2018 to December 2019, 292 acute STAAD patients who underwent aortic surgery
were enrolled in this study. DORA, SORA, and renal malperfusion were diagnosed according
to preoperative aortic enhanced computed tomography (CTA). Renal artery problems secondary
to STAAD were divided into three types: type 1, normal renal artery; type 2, DORA;
and type 3, SORA. Acute kidney injury was divided into three stages: Stage 1, Stage
2, and Stage 3, according to 2012 Kidney Disease: Improving Global Outcomes (KDIGO).
The primary endpoint was all-cause 30-day in-hospital death, and the secondary endpoint
was postoperative dialysis requirement. Univariate and multivariate analyses were
performed to assess the difference among the three types.
Postoperative AKI occurred in 154 of 292 (52.7%) patients, and postoperative dialysis
was present in 27 of 292 (9.2%) patients with STAAD. Postoperative AKI and dialysis
were significantly more prevalent in the SORA group (AKI: 71% in SORA group vs 51.5%
in DORA group vs 22.2% in normal group; postoperative dialysis: 22.2% in SORA group
vs 5.4% in DORA group vs 6.1 in normal group). Thirty-day (30-day) mortality was also
significantly higher in the SORA group (Log-rank test, p=0.012). Preoperative acute
myocardial infarction and body mass index were the independent risk factors for 30-day
mortality. Static obstructive renal artery, cardiopulmonary bypass time, and renal
blood cell transfusion >3 units were the independent risk factors for postoperative
Static obstructive renal artery led to higher 30-day in-hospital mortality and more
postoperative dialysis. Open surgery reduced renal ischaemia injury caused by DORA,
but it could not reduce renal ischaemia injury caused by SORA.