Renal Dysfunction at Discharge and Long-Term Survival in Acute Type A Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Critical Care Medicine

Background:

• Acute type A aortic dissection (ATAAD) is a life-threatening condition requiring surgical repair.
• Renal dysfunction is a known complication of major cardiovascular surgery.
• The long-term prognostic impact of renal dysfunction at discharge following ATAAD repair remains incompletely understood.

Purpose of the Study:

• To investigate the association between renal dysfunction at discharge and long-term survival in patients who underwent surgical repair for ATAAD.
• To identify the specific impact of elevated creatinine and dialysis status on mortality.

Main Methods:

• A retrospective analysis of 784 patients undergoing aortic repair for ATAAD between 2000 and 2021.
• Patients were stratified into two groups based on creatinine levels at discharge: normal creatinine versus elevated creatinine (or on dialysis).
• Survival rates were analyzed using Kaplan-Meier curves and Cox proportional hazards models.

Main Results:

• Patients with elevated creatinine at discharge had significantly higher operative mortality (20% vs. 3.4%) and worse long-term survival (10-year survival: 48% vs. 69%).
• Dialysis at discharge was associated with particularly poor five-year survival (40%) compared to non-dialysis elevated creatinine (80%) and normal creatinine (87%) groups.
• Elevated creatinine at discharge, especially requiring dialysis, was a significant independent risk factor for late mortality.

Conclusions:

• Renal dysfunction at discharge is a critical predictor of both short-term and long-term survival after ATAAD repair.
• Aggressive prevention and management of renal dysfunction, particularly avoiding new-onset dialysis, are crucial for improving patient outcomes.
• These findings underscore the importance of renal function monitoring and intervention in the perioperative care of ATAAD patients.