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


CONCLUSIONS
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.
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Felix
F
Schoenrath
Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Raffael
R
Laber
Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Mergime
M
Maralushaj
Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Deborah
D
Henzi
Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Etem Ibrahim
EI
Caliskan
Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Burkhardt
B
Seifert
Institute of Anesthesiology University Hospital Zurich, Zurich, Switzerland.
Dominique
D
Bettex
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Christoph Thomas
CT
Starck
Department of Cardiothoracic and Vascular Surgery, University of Freiburg, Freiburg, Baden-Würtemberg, Germany.
Martin
M
Czerny
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Volkmar
V
Falk
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D020196:Trauma, Nervous System / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality