Background
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.
Methods
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.
Results
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
dialysis requirement.
Conclusion
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.
Keywords
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References
- The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after surgery for acute type A aortic dissection: a single-center retrospective analysis of 335 patients.Front Med (Lausanne). 2020; 7: 557044
- Preoperative renal malperfusion is an independent predictor for acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection.Eur J Cardiothorac Surg. 2020; 58: 302-308
- Acute kidney injury following acute repair of type A aortic dissection.Ann Thorac Surg. 2020; 111: 1292-1298
- Management of malperfusion: New York approach and outcomes.J Card Surg. 2021; 36: 1757-1765
- Renal malperfusion affects operative mortality rather than late death following acute type A aortic dissection repair.Asian J Surg. 2020; 43: 213-219
- The AATS Clinical Practice Standards Committee: Adult Cardiac Surgery, 2021. The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection.J Thorac Cardiovasc Surg. 2021; 62: 735-758
- Simultaneous fenestration with stent implantation for acute limb ischemia due to type B acute aortic dissection complicated with both static and dynamic obstructions.Ann Thorac Cardiovasc Surg. 2012; 18: 158-161
- KDIGO Clinical Practice Guideline for Acute Kidney Injury.Kidney International Supplements. 2012; 2: 138
- Immediate operation for acute type A aortic dissection complicated by visceral or peripheral malperfusion.J Thorac Cardiovasc Surg. 2018; 156: 18-24.e3
- Coronary malperfusion due to type A aortic dissection: mechanism and surgical management.Ann Thorac Surg. 2003; 76: 1471-1476
- Influence of body mass index on outcomes of patients undergoing surgery for acute aortic dissection: a propensity-matched analysis.Tex Heart Inst J. 2019; 46: 7-13
- Association of initiation of dialysis with hospital length of stay and intensity of care in older adults with kidney failure.JAMA Netw Open. 2020; 3: e200222
- The burden of acute kidney injury and related financial issues.Contrib Nephrol. 2018; 193: 100-112
- Short-term dialysis catheter versus central venous catheter infections in ICU patients: a post hoc analysis of individual data of 4 multi-centric randomized trials.Intensive Care Med. 2019; 45: 1774-1782
- Relationship between renal function and renal artery involvement in acute Debakey type I aortic dissection.Heart Surg Forum. 2020; 23: E465-E469
- Successful repair of acute type B and retrograde type A aortic dissection with kidney ischemia.Vasc Endovascular Surg. 2017; 51: 342-345
- Endovascular repair of thrombosed-type acute type A aortic dissection with critical renal artery malperfusion.Eur J Cardiothorac Surg. 2018; 54: 1142-1144
- Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study.BMC Nephrol. 2019; 20: 368
Article info
Publication history
Published online: January 21, 2022
Accepted:
November 9,
2021
Received in revised form:
October 30,
2021
Received:
June 22,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
