Total arch replacement in patients with chronic kidney disease

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Anesthesiology

Background:

• Investigated the impact of preoperative renal dysfunction on outcomes after elective isolated total arch replacement (TAR).
• Utilized mild hypothermic lower body circulatory arrest with antegrade selective cerebral perfusion (SCP).

Purpose of the Study:

• To determine if preoperative renal dysfunction (eGFR < 60 ml/min/1.73 m²) is associated with adverse postoperative outcomes in patients undergoing elective isolated TAR.
• To compare perioperative data and mid-term outcomes between patients with and without chronic kidney disease.

Main Methods:

• Retrospective analysis of 144 patients undergoing elective isolated TAR (January 2002 - December 2019).
• Patients grouped by preoperative eGFR (< 60 vs. ≥ 60 ml/min/1.73 m²).
• Adjusted analysis using weighted logistic regression and inverse probability of treatment weighting.

Main Results:

• A higher incidence of postoperative stroke was observed in the chronic kidney disease group (eGFR < 60 ml/min/1.73 m²) compared to the normal group (2.8% vs. 0%, p=0.049).
• No significant differences in 30-day mortality, hospital mortality, or overall survival were found between the groups.
• Multivariate analysis indicated that eGFR < 60 ml/min/1.73 m² was not an independent predictor of adverse outcomes (HR: 1.636, p=0.156).

Conclusions:

• Preoperative renal dysfunction (eGFR < 60 ml/min/1.73 m²) is not associated with significantly worse mid-term outcomes after elective isolated total arch replacement with SCP.
• These findings suggest that patients with moderate renal impairment may safely undergo this complex aortic procedure.