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The Impact of Renal Dysfunction at Discharge on Long-term Survival Following Acute Type A Aortic Dissection Repair
Elizabeth L. Norton1, Xiaoting Wu2, Karen M. Kim2, Himanshu J. Patel2, G Michael Deeb2, Bo Yang2.
1Creighton University, Omaha, NE, USA, 2University of Michigan, Ann Arbor, MI, USA.

OBJECTIVE: Acute renal injury is a common complication of acute type A aortic dissection (ATAAD). The long-term outcome for ATAAD patients who survive the operation but suffer renal dysfunction at discharge remains unknown. We aimed to determine the impact of renal dysfunction at discharge on long-term survival in patients with ATAAD following surgery.
METHODS: From 2000-2018, 556 patients underwent open aortic repair for an ATAAD. Patients were stratified based on creatinine (Cr) level at discharge (including alive and dead) into two groups: normal-Cr at discharge (n=420) and elevated-Cr defined as >1.3 mg/dL for males and >1.0 mg/dL for females (n=136).
RESULTS: Both groups had similar ATAAD repair procedures. The elevated-Cr group required significantly more intraoperative packed red blood cell transfusions and had significantly worse postoperative outcomes, including an eight times higher operative mortality, in-hospital or mortality within 30 days of surgery, (24% vs. 3%, p<0.0001) (Table). The landmark survival analysis at discharge showed that if patients were discharged with an elevated-Cr without dialysis, their survival was worse than the normal-Cr group, (10-year survival: 57% vs. 75%, p=0.003), but much better than those on dialysis at discharge (5-year survival: 82% vs. 41%, p=0.0005). (Figure). Elevated Cr at discharge on dialysis was a significant risk factor for late mortality (hazard ratio=4.8, p=0.0003), by Cox model.
CONCLUSIONS: Renal dysfunction at discharge, even not on dialysis, indicates significantly decreased short- and long-term survival following open ATAAD repair. Surgeons should strive to aggressively prevent renal dysfunction, especially dialysis, at discharge to improve long-term survival.

Table. Postoperative Outcomes
Normal Creatinine at Discharge (n=420)Elevated Creatinine at Discharge(n=136)p-value
Reoperation for bleeding28 (6.7)17 (12.5)0.03
Cerebrovascular accident24 (5.7)14 (10)0.06
New-onset renal failure27 (6.4)56 (41)<.0001
Deep sternal infection3 (0.7)5 (3.7)0.02
Sepsis5 (1.2)7 (5.1)0.01
Need for tracheostomy6 (1.4)9 (6.6)0.003
Pneumonia55 (13)36 (26)0.0002
Postop length of stay (days)10 (7, 14.5)15 (8, 25)<.0001
Operative Mortality12 (2.9)33 (24)<.0001


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