Open repair of descending thoracic and thoracoabdominal aortic aneurysms in patients with preoperative renal failure

Objectives: To evaluate surgical outcomes in open repair of thoracoabdominal aortic (TAAA) and descending thoracic aortic aneurysms (DTA) in patients with preoperative renal failure (PRF).

Methods: Our database was examined for all patients undergoing open TAAA/DTA repair. Patients with a creatinine greater than or equal to 1.5 gm/dl or on haemodialysis were defined as having PRF and were compared to those having normal preoperative renal function. Logistic and Cox regression analysis were used to identify independent determinants of in-hospital outcomes and long-term survival.

Results: From 1997 to 2015, 711 patients underwent open TAAA/DTA repair. Two hundred and two were categorized as having PRF, of which, 22 where on preoperative haemodialysis. PRF patients had significantly worse comorbidities; smoking (95.5% vs 69.0%; P < 0.001), chronic pulmonary disease (65.8% vs 29.7%; P < 0.001), peripheral vascular disease (44.1% vs 19.4%; P < 0.001) and diabetes (16.3% vs 6.7%; vs P < 0.001). Operative mortality (OM) was seven-times higher in patients with PRF (14.2 vs 2.2%; P < 0.001). Logistic regression analysis showed that PRF was a predictor of OM [odds ratio (OR): 4.91; confidence interval (CI): 2.01-11.97; P < 0.001] and major adverse events (OR: 2.05; CI: 1.21-3.46; P = 0.007). Kaplan-Meier 5-years survival was significantly lower in PRF patients (45.0% vs 69.8%; P < 0.001).

Conclusions: PRF predicts higher OM and major adverse events incidence following open TAAA/DTA repair. Long-term survival is negatively impacted. Strategies for improving preoperative and intraoperative renal function may lead to better outcomes.