Risk factors for severe acute kidney injury post complication after total arch replacement combined with frozen elephant trunk, in acute type A aortic dissection

Abstract

Background: Total arch replacement with the frozen elephant trunk (TAR + FET) technique is a challenging approach for acute type A aortic dissection (ATAAD). Severe acute kidney injury (AKI) adversely affects the prognosis of hospitalized patients. The study aims to evaluate the incidence and risk factors of severe AKI. Methods: We conducted a retrospective cross-sectional study of the records of ATAAD patients following TAR + FET, admitted between January 2013 and December 2018. A multivariate logistic regression model was used to identify predictors of severe postoperative AKI. Severe postoperative AKI was defined using the Kidney Disease Improving Global Outcomes criteria. Results: The whole in-hospital mortality rate was 4.3%. Among 670 patients, major adverse outcomes were present in 169 patients (25.2%), 67 patients (10.0%) required renal replacement therapy (RRT), and 80 (11.9%) developed severe postoperative AKI. In-hospital mortality in the severe AKI group (13.8%) was 4.5 times higher than in the non-severe AKI group (3.1%). Compared with the non-severe AKI patients, the severe AKI patients had a higher incidence of major adverse outcomes (100% vs. 15.1%, P<0.001) and more frequent use of RRT (83.8% vs. 0.0%, P<0.001). Multivariate analysis revealed that severe postoperative AKI was predicted by advanced age [odds ratio (OR) =1.029; 95% confidence interval (CI): 1.002–1.056; P=0.032], lower limb symptoms (OR =4.384; 95% CI: 2.240–8.582; P<0.001), coronary artery involvement (OR =2.478; 95% CI: 1.432–4.288; P=0.001), preoperative postoperative serum creatinine (SCr) (OR =1.008; 95% CI: 1.003–1.013; P=0.001), and prolonged cardiopulmonary bypass (CPB) time (OR =1.011; 95% CI: 1.006–1.015; P<0.001). Conclusions: There was a high incidence of severe AKI and high in-hospital mortality after TAR + FET in ATAAD patients. The risk factors for severe AKI in ATAAD patients undergoing TAR + FET were determined to help identify the high-risk patients and make rational treatment decisions.