Elective proximal aortic surgery in patients with renal insufficiency

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Outcomes Research

Background:

• Preoperative renal insufficiency (PRI) is a significant concern in patients undergoing major aortic surgery.
• Evaluating risk factors and outcomes in this population is crucial for surgical planning and patient care.

Purpose of the Study:

• To assess preoperative risk factors and postoperative outcomes in patients with PRI undergoing open repair of the aortic root, ascending aorta, or aortic arch.
• To identify independent predictors of adverse events in this patient cohort.

Main Methods:

• A review of an institutional database identified 2140 patients undergoing elective open aortic repairs.
• Patients were stratified into two groups: those with PRI (n=55) and those with normal renal function.
• Regression analyses were employed to determine predictors of short- and long-term outcomes.

Main Results:

• Patients with PRI were older, had poorer cardiovascular profiles, and lower ejection fractions.
• Reoperation for bleeding was the most common major complication in the PRI group (9.1%).
• PRI and left ventricular ejection fraction independently predicted major adverse events; long-term survival was reduced in the PRI cohort.

Conclusions:

• Preoperative renal insufficiency is associated with a higher risk profile and mortality in aortic surgery patients.
• Renal insufficiency is an independent predictor of adverse outcomes, highlighting the need for targeted interventions to improve patient management and results.