title: Open repair of descending thoracic and thoracoabdominal aortic aneurysms in patients with preoperative renal failure.
abstract: OBJECTIVE
  To evaluate surgical outcomes in open repair of thoracoabdominal aortic (TAAA) and descending thoracic aortic aneurysms (DTA) in patients with preoperative renal failure (PRF).
  
  
  METHODS
  Our database was examined for all patients undergoing open TAAA/DTA repair. Patients with a creatinine greater than or equal to 1.5 gm/dl or on haemodialysis were defined as having PRF and were compared to those having normal preoperative renal function. Logistic and Cox regression analysis were used to identify independent determinants of in-hospital outcomes and long-term survival.
  
  
  RESULTS
  From 1997 to 2015, 711 patients underwent open TAAA/DTA repair. Two hundred and two were categorized as having PRF, of which, 22 where on preoperative haemodialysis. PRF patients had significantly worse comorbidities; smoking (95.5% vs 69.0%; P  < 0.001), chronic pulmonary disease (65.8% vs 29.7%; P  < 0.001), peripheral vascular disease (44.1% vs 19.4%; P  < 0.001) and diabetes (16.3% vs 6.7%; vs P  < 0.001). Operative mortality (OM) was seven-times higher in patients with PRF (14.2 vs 2.2%; P  < 0.001). Logistic regression analysis showed that PRF was a predictor of OM [odds ratio (OR): 4.91; confidence interval (CI): 2.01-11.97; P  < 0.001] and major adverse events (OR: 2.05; CI: 1.21-3.46; P  = 0.007). Kaplan-Meier 5-years survival was significantly lower in PRF patients (45.0% vs 69.8%; P  < 0.001).
  
  
  CONCLUSIONS
  PRF predicts higher OM and major adverse events incidence following open TAAA/DTA repair. Long-term survival is negatively impacted. Strategies for improving preoperative and intraoperative renal function may lead to better outcomes.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
authors.forename: Lucas B
authors.initials: LB
authors.lastname: Ohmes
authors.forename: Christopher
authors.initials: C
authors.lastname: Lau
authors.forename: Antonino
authors.initials: A
authors.lastname: Di Franco
authors.forename: Ivancarmine
authors.initials: I
authors.lastname: Gambardella
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elsayed
authors.forename: Fawad
authors.initials: F
authors.lastname: Hameedi
authors.forename: Monica
authors.initials: M
authors.lastname: Munjal
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Descending thoracic aortic aneurysm; Open repair; Preoperative renal failure; Surgical outcomes; Thoracoabdominal aortic aneurysms