Clinical Features and Risk Factors for Renal Failure after Total Aortic Arch Repair

Objectives: Renal failure is a common and dreaded complication after total aortic arch repair under hypothermic circulatory arrest (HCA) and is associated with significant mortality and morbidity. We sought to assess clinical features and risk factors of renal failure after total aortic arch repair.

Methods: Between 2010 and 2015, 199 patients (61% male, 63 years [52–70]) underwent total aortic arch repair in our institution. 44% presented with acute dissection, 22% with chronic dissection and 34% with degenerative aneurysms.

Results: Preoperative glomerular filtration rate (GFR) was 85ml/min (65–112), 18% of patients presented with reduced renal function. 24% (N = 47) developed acute kidney injury (AKI), 21% (N = 41) needed dialysis. Of these, 19/41 patients died (43%), in 14/41 patients renal function recovered (34%), 8 patients were discharged on dialysis (20%). Patients with AKI more often had chronic dissection (p = 0.044), had a significant higher mortality (43% versus 7.2%, p < 0.0001), higher rate of postoperative low cardiac output (p < 0.001), re-thoracotomy for bleeding (p = 0.0063), respiratory insufficiency (p < 0.0001) and new onset permanent neurological deficit (p = 0.0014). Chronic dissection, preoperative GFR, operation time, rethoracotomy for bleeding and post-operative low cardiac output were independent risk factors for renal failure. HCA time and temperature were not identified as risk factors.

Conclusions: Postoperative renal failure after total aortic arch repair is associated with significant mortality. Patients with chronic dissection and preoperative renal impairment might benefit from additional protective measures (e.g., lower body perfusion). Perioperative management has to prevent low cardiac output and bleeding complications during the postoperative course.