Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair

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• 作者：Yusuke Sasabuchi ; MD ; MPH^a ; ^b ; ^{sasabuchi-tky@umin.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Naoyuki Kimura ; MD ; PhD^c ; Junji Shiotsuka ; MD^b ; Tetsuya Komuro ; MD^b ; Hideyuki Mouri ; MD^b ; Tetsu Ohnuma ; MD^b ; Kayo Asaka ; MD^b ; Alan K. Lefor ; MD ; PhD^d ; Hideo Yasunaga ; MD ; PhD^a ; Atsushi Yamaguchi ; MD ; PhD^c ; Hideo Adachi ; MD ; PhD^c ; Masamitsu Sanui ; MD ; PhD^b
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：102
• 期：6
• 页码：2003-2009
• 全文大小：354 K

文摘

Although acute kidney injury (AKI) is known as a serious complication after operation for acute type A aortic dissection (AAAD), the long-term impact of AKI remains unclear. The aim of the present study is to investigate the long-term survival in patients with AKI after operation for AAAD.

Methods

This study included 403 patients who underwent operation for AAAD from 1990 to 2011 at Jichi Medical University, Saitama Medical Center. Postoperative AKI was identified according to the Kidney Disease Improving Global Outcomes criteria. Kaplan-Meier survival analysis and Cox proportional hazards regression were modeled to analyze the association between the AKI stage and postoperative long-term survival.

Results

Of 403 patients, 181 (44.9%) experienced postoperative AKI. Kaplan-Meier estimates for long-term survival were significantly different among patients without AKI and patients with stage 1, 2, and 3 AKI (p < 0.001). Hazard ratios of long-term survival for patients with stages 1, 2, and 3 AKI compared with patients without AKI were 1.38 (95% confidence interval [CI]: 0.84 to 2.26), 1.82 (95% CI: 0.95 to 3.51), and 3.79 (95% CI: 1.95 to 7.37), respectively. More patients with AKI died because of cardiovascular disease after discharge than patients without AKI (1.8% versus 6.0%, p = 0.03).

Conclusions

Stage 3 AKI is significantly associated with lower long-term survival after operation for AAAD. Patient follow-up after discharge that focuses on cardiovascular issues may benefit patients who survive AKI after AAAD operation.