Survival, Neurologic Injury, and Kidney Function after Surgery for Acute Type A Aortic Dissection.

Schoenrath, Felix; Laber, Raffael; Maralushaj, Mergime; Henzi, Deborah; Caliskan, Etem Ibrahim; Seifert, Burkhardt; Bettex, Dominique; Starck, Christoph Thomas; Czerny, Martin; Falk, Volkmar

BACKGROUND To analyze survival, neurologic injury, and kidney function after acute type A aortic dissection. METHODS A total of 445 patients undergoing surgery for acute type A aortic dissection were analyzed. Evaluation according to risk factors for mortality, neurologic injury, and kidney function was performed. RESULTS Overall 1-, 5-, and 10-year survival rates were 82.8 ± 1.8%, 73.6 ± 2.4%, and 59.3 ± 3.9, respectively. Independent preoperative risk factors for mortality were preexisting renal impairment (p = 0.001), reduced left ventricular ejection fraction (p < 0.001), and age (p < 0.001). Perioperative risk factors were prolonged cross-clamp (p < 0.001) and cerebral perfusion time (p = 0.001). Risk factors for renal failure were preexisting renal impairment (p < 0.001), prolonged cross-clamp time (p < 0.001), cerebral perfusion time (p < 0.001), and age (p = 0.022). Risk factors for neurologic injury were cross-clamp time (p = 0.038), cerebral perfusion time (p = 0.007), and age (p = 0.045). CONCLUSION In addition to classic risk factors, survival after type A aortic dissection is affected by preexisting renal impairment. Preexisting renal impairment is predictive of postoperative renal failure. Therefore treatment and prevention strategies for renal failure during the acute and long-term course after acute type A aortic dissection are warranted.