title: Prognostic Implications of Acute Renal Failure after Surgery for Type A Acute Aortic Dissection.
abstract: BACKGROUND
  "Type A" acute aortic dissection (AAAD) is the most challenging among the emergency operations in cardiac surgery. The aim of this study was the evaluation of the role of acute renal failure (ARF) in postoperative survival of patients operated for AAAD.
  
  
  METHODS
  From February 2010 to April 2012, 37 consecutive patients were operated at our department for AAAD. We studied our population by subdividing the patients within groups according to the presence of ARF requiring continuous veno-venous hemofiltration (CVVH) and according to hypothermic circulatory arrest (HCA) times and degrees.
  
  
  RESULTS
  The overall 30-day mortality was 27% (50% group A with ARF, 13% group B no ARF). Acute renal failure requiring CVVH was 37.8%. Multivariate analysis revealed a significant association with 30-day mortality (odds ratio 6.6 and p = 0.020). Preoperative oliguria [urine output less than 30 ml/h (odds ratio 4.7 p = 0.039)], CPB greater than 180 minutes (odds ratio 6.5 p = 0.023) and postoperative bleeding requiring a surgical reopening (odds ratio 12.2 and p = 0.021) were the variables significantly associated with acute kidney injury.
  
  
  CONCLUSIONS
  The data obtained from our analysis bring out the high incidence of renal injuries after surgery for AAAD, and indicate a negative impact on renal injuries of a preoperative oliguria, longer Cardiopulmonary bypass (CBP)/HCA times, and postoperative bleeding requiring a surgical revision. Our data also suggest a better 30-day survival and better renal outcomes in case of shorter HCA and lesser degree of hypothermia. The option of lesser and shorter hypothermia may be very useful, especially for the elderly patients and octogenarians.
authors.affiliation: Division of Cardiac Surgery, Papardo Piemonte Hospital, Messina, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sansone
authors.affiliation: Division of Cardiac Surgery, Papardo Piemonte Hospital, Messina, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morgante
authors.affiliation: Division of Cardiac Surgery, Papardo Piemonte Hospital, Messina, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ceresa
authors.affiliation: Division of Cardiac Surgery, Papardo Piemonte Hospital, Messina, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Salamone
authors.affiliation: Division of Cardiac Surgery, Papardo Piemonte Hospital, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Patanè
keywords: Acute aortic dissection; Acute renal failure; Continous veno-venous hemofiltration; Hypothermic circulatory arrest; Type A