Renal Failure in Type A-Aortic Dissection Repair: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis

Ashwin Palaniappan; Levi N Bonnell; David Blitzer; Hiroo Takayama; Tsuyoshi Kaneko; Robert H Habib; Frank W Sellke

doi:10.1016/j.athoracsur.2024.12.012

Renal Failure in Type A-Aortic Dissection Repair: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis

Ann Thorac Surg. 2024 Dec 24:S0003-4975(24)01118-4. doi: 10.1016/j.athoracsur.2024.12.012. Online ahead of print.

Authors

Ashwin Palaniappan¹, Levi N Bonnell², David Blitzer³, Hiroo Takayama³, Tsuyoshi Kaneko⁴, Robert H Habib³, Frank W Sellke⁵

Affiliations

¹ Brown University, Providence, RI.
² Columbia University, New York, NY.
³ Society of Thoracic Surgeons Research and Analytic Center, Chicago, IL.
⁴ Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO.
⁵ Brown University, Providence, RI. Electronic address: [email protected].

PMID: 39725252
DOI: 10.1016/j.athoracsur.2024.12.012

Abstract

Background: We sought to identify predictors of acute renal failure (ARF) following acute type A aortic dissection (ATAAD) and its implications on postoperative outcomes.

Methods: ATAAD cases were identified from The Society of Thoracic Surgeons - Adult Cardiac Surgery Database (2017-2022). Cases with chronic dissection, prior aortic repair, primary endovascular repair, preoperative extracorporeal membrane oxygenation, preoperative renal failure, and operative room deaths were excluded. ARF was defined as either a threefold increase in creatinine or creatinine >4 mg/dL with an increment ≥0.5 mg/dL from baseline, or new dialysis requirement postoperatively. Predictors of ARF were identified using multivariable logistic regression with corresponding adjusted odds ratios [AOR (95% Confidence Intervals)].

Results: Among 22,313 patients (age: 60.2±13.7 years; 66.2% male) undergoing ATAAD repair at 868 hospitals, 3,696 (16.6%) developed ARF and, of these, 2,918 (79.0%) required dialysis. ATAAD volume increased from 3,693 in 2017 to 4,334 in 2022 (p<0.001), while the proportion of ARF decreased slightly yet significantly from 17.2% in 2017 to 16.3% in 2022 (p<0.001). A well calibrated and discriminating (C-Statistic: 0.77 (0.75, 0.78)) multivariable model identified 27 independent predictors of ARF. Bilateral renal malperfusion (AOR=4.88 (3.50-6.81)), preoperative creatinine per 0.1 mg/dL (AOR=1.12 (1.11-1.14)), intraoperative transfusion (AOR=1.63 (1.21-2.18)), and cardiogenic shock (AOR=1.46 (1.24-1.72)) were strongly associated with increased ARF. Conversely, female gender (AOR=0.72 (0.61-0.86)) was protective. Failure-to-rescue after ARF following ATAAD repair was 42%.

Conclusions: This study identified patient factors that significantly increase the risk of ARF following ATAAD repair, which may alert the clinical team to implement potential protective interventions.