Impact Of Renal Artery Involvement On Early- And Mid-term Outcomes Of Patients Undergoing Aortic Repair With Acute Type A Aortic Dissection

Objective:To analyze the effects of renal artery involvement on the early-and mid-term outcomes for patients with acute type A aortic dissection.Methods:Between October 2015 to December 2016,173 patients with Stanford type A aortic dissection who underwent surgical treatment in our hospital were investigated retrospectively.Of the 173 patients,145(83.82%)were males,28(16.18%)were females.According to the results of preoperative chest and abdomen aortic CTA examination,he patients were divided into two groups.96 of whom with renal artery involvement were defined as Group A,and 77 without renal artery involvement were defined as Group B.Preoperative data,ntraoperative and postoperative conditions,and mid-term follow-up information were collected.The perioperative clinical outcomes and mid-term outcomes were compared between the two groups.Kaplan-Meier curves were generated,and a log-rank test was used for comparison between the 2 groups.Risk factors for metaphase prognosis of the patients were investigated by log-rank test and multivariable Cox regression models.Results: There was no significant difference in preoperative clinical data between the two groups.In the aspects of general information,operativetime,cardiopulmonary bypass time,aortic occlusion time,selective cerebral perfusion time,and deep hypothermic circulatory time had no statistical significance.Also,there was no significant difference in hospital mortality between the two groups(6.25% vs 5.19%,P>0.05).Group A was associated with significantly higher incidences of acute kidney injury(50.0% vs 32.47%,P<0.05)and the renal replacement therapy(17.71% vs 5.19%,P<0.05).Multivariate analysis revealed that the independent predictors of AKI after acute type A aortic dissection include age more than 75 years(OR 2.823 95% CI,1.006 vs 7.918;P = 0.049),renal artery involvement(OR 2.556;95% CI,1.199 vs 5.452;P= 0.015)and preoperative acute renal insufficiency(OR 11.282;95% CI,3.420 vs 37.211;P<0.001).The mean follow-up time was 25.15±9.00 months,and 3 patients were lost during the follow-up.As of December 31,2018,a total of 149 patients survived and 11 patients died(group A:7 vs group B:4).The overall 3-year actuarial survival rates of the A and B group were 80.5% vs 87.2%(p=0.544),which has no significant difference.Multivariate analysis revealed that the independent predictors of mid-term was ventilator assist time(OR 1.005;95%CI,1.001~1.010;P=0.014).Conclusions: Renal artery involvement does not increase the hospital mortality rate,but significantly increases the incidence of AKI,which is an independent risk factor for AKI.There was no significant difference in the median mortality between the two groups.As long as the perioperative period strengthens renal function management,satisfactory mid-term results can be obtained.