Significance of preoperative acute kidney injury in patients with acute type A aortic dissection

Acute type A aortic dissection (AAD) is a medical emergency with high mortality even with emergency repair. We explored the risk factors for in-hospital mortality and the impact of preoperative acute kidney injury (AKI) in patients with AAD.

Our hospital database contained records for 156 consecutive patients who underwent AAD repair between March 2000 and February 2013. They were assigned to the in-hospital mortality or the survival group. All data were collected retrospectively.

The 30-day mortality, including intraoperative deaths, was 14.1% (22/156). Total in-hospital mortality was 19.2% (30/156). Patients who required preoperative cardiopulmonary resuscitation (CPR) (16.7 vs 3.2%; P = 0.012), or who presented with preoperative cardiac tamponade (46.7 vs 19.0%; P = 0.002), shock/hypotension (56.7 vs 21.4%; P < 0.001), or coma (20.0 vs 6.3%; P = 0.019) had a higher in-hospital mortality rate. There was no difference in in-hospital mortality rate between patients with preoperative AKI or not. Mortality and major complications were significantly correlated with the severity of AKI. Multivariate analysis confirmed that preoperative shock or hypotension (odds ratio = 5.2; 95% CI = 2.2-12.3), and preoperative AKI stage 3 (odds ratio = 4.9; 95% CI = 1.3-19.3) were independent preoperative prognostic factors of in-hospital mortality.

On the basis of our results, preoperative stage 3 AKI is a crucial prognostic risk factor for patients with AAD repair, Cardiac surgeons should be aware of this condition when dealing with AAD patients.