Analysis of Risk Factors for Acute Kidney Injury after Ascending Aortic Replacement Combined with Open Placement of Triple-Branched Stent Graft in Type A Aortic Dissection: A New Technique versus the Traditional Method in a Single Chinese Center
Zhihuang Qiu, Liangwan Chen, Hua Cao, Guican Zhang, Fan Xu, Qiang Chen
Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
Med Sci Monit 2015; 21:674-680
We aimed to analyze the risk factors and prognosis of acute kidney injury (AKI) after aortic arch repair in type A aortic dissection.
Material and Methods: We included 155 patients undergoing arch repair surgery for type A aortic dissection from January 2009 to January 2014 in our hospital. Ninety-three patients underwent ascending aortic replacement combined with open placement of triple-branched stent graft and 62 underwent arch replacement with 4-branched Dacron graft combined with stented elephant trunk implantation into the descending aorta. Univariate analysis and multiple logistic regression were performed to evaluate possible parameters associated with AKI according to the AKI Network (AKIN).
Results: Postoperative AKI occurred in 56 patients, with a morbidity of 36.13%. Advanced age (OR=2.32 per decade, 95% CI; range, 1.47–3.67); aortic arch replacement with 4-branched Dacron graft combined with stented elephant trunk implantation (OR=3.29, 95% CI; range, 1.12–9.67); cardiopulmonary bypass time >180 min (OR=3.91, 95% CI; range, 1.35–11.35) and packed red blood cells >10 U (OR=4.88, 95% CI; range, 2.03–11.76) were independent risk factors.
Conclusions: AKI is a complication after arch repair in type A aortic dissection. Advanced age; aortic arch replacement with 4-branched Dacron graft combined with stented elephant trunk implantation; cardiopulmonary bypass time >180 min; and packed red blood cells >10 U were independent risk factors for AKI. Ascending aortic replacement combined with open triple-branched stent graft placement could reduce the occurrence of AKI and protect renal function.
Keywords: Adult, Acute Kidney Injury - etiology, Aneurysm, Dissecting - surgery, Aorta, Thoracic - surgery, Aortic Aneurysm - surgery, Blood Vessel Prosthesis - adverse effects, Blood Vessel Prosthesis Implantation - adverse effects, China, Female, Humans, Male, Middle Aged, Risk Factors, Stents - adverse effects, Vascular Surgical Procedures - methods, young adult