Renal Failure in Type A Aortic Dissection Repair: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis

Background: We sought to identify predictors of acute renal failure (ARF) after acute type A aortic dissection (ATAAD) and its implications for postoperative outcomes. Methods: ATAAD cases were identified from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (2017-2022). Cases with chronic dissection, prior aortic repair, primary endovascular repair, preoperative extracorporeal membrane oxygenation, preoperative renal failure, and operative room deaths were excluded. ARF was defined as either a 3-fold increase in creatinine concentration or creatinine concentration >4 mg/dL with an increment ≥0.5 mg/dL from baseline or new dialysis requirement postoperatively. Predictors of ARF were identified by multivariable logistic regression with corresponding adjusted odds ratio (AOR [95% CI]). Results: Of 22,313 patients (age, 60.2 ± 13.7 years; 66.2% male) undergoing ATAAD repair at 868 hospitals, 3696 (16.6%) had ARF, and of these, 2918 (79.0%) required dialysis. ATAAD volume increased from 3693 in 2017 to 4334 in 2022 (P < .001), whereas the proportion of ARF decreased slightly yet significantly from 17.2% in 2017 to 16.3% in 2022 (P < .001). A well-calibrated and discriminating (C statistic, 0.77 [0.75-0.78]) multivariable model identified 27 independent predictors of ARF. Bilateral renal malperfusion (AOR, 4.88 [3.50-6.81]), preoperative creatinine per 0.1 mg/dL (AOR, 1.12 [1.11-1.14]), intraoperative transfusion (AOR, 1.63 [1.21-2.18]), and cardiogenic shock (AOR, 1.46 [1.24-1.72]) were strongly associated with increased ARF. Conversely, female sex (AOR, 0.72 [0.61-0.86]) was protective. Failure to rescue after ARF following ATAAD repair was 42% Conclusions: This study identified patient factors that significantly increase the risk of ARF after ATAAD repair that may alert the clinical team to implement potential protective interventions.