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Acute Kidney Injury Affects Mid-Term Outcomes of Thoracoabdominal Aortic Aneurysms Repair

Soichiro Henmi1, Yutaka Okita2, Yojiro Koda1

  • 1Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

Seminars in Thoracic and Cardiovascular Surgery
|June 5, 2021
PubMed

Insights

Postoperative acute kidney injury (AKI) significantly impacts mid-term survival after thoracoabdominal aortic aneurysm (TAAA) repair. Severe AKI increases in-hospital deaths, while moderate to severe AKI negatively affects long-term survival rates.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Vascular Surgery

Background:

  • Mid-term outcomes after thoracoabdominal aortic aneurysm (TAAA) repair are influenced by various factors.
  • The specific impact of postoperative acute kidney injury (AKI) on these mid-term outcomes remains incompletely understood.
  • Understanding AKI's role is crucial for improving patient prognosis following complex aortic repair.

Purpose of the Study:

  • To investigate the association between postoperative acute kidney injury (AKI) and mid-term survival after thoracoabdominal aortic aneurysm (TAAA) repair.
  • To analyze the impact of different AKI severity grades (mild, moderate, severe) on patient outcomes.
  • To identify risk factors influencing mid-term survival in TAAA repair patients who develop AKI.

Main Methods:

  • Retrospective analysis of 294 consecutive TAAA repairs performed between October 1999 and March 2019.
  • Exclusion of patients with end-stage renal disease requiring hemodialysis and intraoperative deaths, leaving 281 patients for analysis.
  • AKI classification based on Kidney Disease: Improving Global Outcomes (KDIGO) guidelines; assessment of in-hospital mortality and 4-year survival rates.

Main Results:

  • 178 patients (63.3%) developed AKI, with 46 (16.4%) experiencing severe AKI.
  • Severe AKI was strongly associated with increased in-hospital mortality (7.1%, p < .001).
  • 4-year survival rates significantly decreased with increasing AKI severity: 91.9% (no AKI), 72.4% (moderate AKI), and 32.6% (severe AKI) (p < .001).

Conclusions:

  • Postoperative moderate and severe AKI are significant negative predictors of mid-term survival following TAAA repair.
  • Severe AKI is a critical factor for in-hospital mortality in this patient cohort.
  • Strategies aimed at preventing moderate to severe AKI could substantially improve long-term survival after TAAA repair.
Keywords:
Acute kidney injuryRenal functionThoracoabdominal aortic aneurysm

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