Influence of Acute Kidney Injury in Patients with Acute Aortic Dissection Type A

Objectives: Despite all progress in cardiovascular surgery, perioperative management in acute aortic dissection type A (AADA) remains challenging. Acute kidney injury (AKI) is one of the most feared postoperative complications after AADA surgery and its influence on postoperative outcome was evaluated with this large retrospective study.

Methods: Our institutional aortic database was reviewed and a total of 363 consecutive patients with surgery of AADA between 2001 and 2016 were identified.

The patient’s pre- and postoperative data were compared with main focus on renal function. AKI was classified according to the KDIGO guidelines. The cohort was divided and compared to patients without AKI after surgery (non-AKI) and to patients with AKI (With-AKI) after the procedure.

Results: The mean age was 62.6 ± 12.8, respectively, 63.3 ± 11.2 years (non-AKI vs. With-AKI); in both groups, gender was comparably distributed.

Chronic renal insufficiency was more often known in patients from the With-AKI group (10.6 vs. 24.3%, p = 0.002), which is reflected also in higher creatinine levels (cutoff >200 µmol/L) at admission in those patients (86 (71; 106) vs. 103 (86; 139); p < 0.001).

At the time of admission, the patients from the With-AKI group were significant more often in cardiogenic shock (5.7 vs. 14.1%, p = 0.013) and required cardiopulmonary resuscitation (4.3 vs. 21.8%, p > 0.001) and consecutively were also more often intubated (7.8 vs. 17.9%, p = 0.008).

Intraoperative analysis revealed similar cardiopulmonary bypass time, cross-clamp time, and time of circulatory arrest. However, the total length of the surgical procedure was longer in the With-AKI group (p = 0.034).

In the With-AKI group, AKI stages 1 and 2 occurred in 1.3% each, in 97.4% of those patients stage 3 was diagnosed. A new-onset hemodialysis was required in 97.5% of the With-AKI patients. The time of mechanical ventilation (41 [17; 143] vs. 161 [81; 433] hours, p < 0.001), intensive care unit stay (5 [2; 9] vs. 11 [4; 20] days, p < 0.001), as well as the rate of resuscitation (4.6 vs. 19%, p < 0.001) and blood transfusion (64.1 vs. 94.6%, p < 0.001) were higher in With-AKI patients. The 30-day mortality in patients without AKI was significant lower than those with AKI (9.2 vs. 43.8%, p < 0.001).

Conclusion: In our analysis, AKI after surgery in AADA is associated with an impaired outcome reflected by significant higher postoperative morbidity and 30-day mortality.