Acute Kidney Injury after Acute Type A Aortic Dissection Repair with Hemiarch Replacement under Hypothermic Circulatory Arrest

Introduction: Acute type A aortic dissection (ATAAD) repair is associated with high mortality rate and postoperative complications including renal dysfunction. The incidence of postoperative acute kidney injury (AKI) and the risk factors for new renal replacement therapy (RRT) in patients who underwent ATAAD repair under hypothermic circulatory arrest is described. Patients and Methods: Between 2002 and 2022 two hundred and twenty-three patients underwent ATAAD repair with hemiarch replacement under hypothermic circulatory arrest. Postoperative AKI was evaluated according to Kidney Disease/Improving Global Outcomes (KDIGO) criteria. Results: Median age of patients was 63 (53–71) years old. Postoperative AKI was observed in 140 patients (62.8%). The patients with postoperative AKI classified by KDIGO stages: 1 = 53 (23.8%), 2 = 36 (16.1%) and 3 = 51 (22.9%) patients. Twenty-eight patients (12.6%) underwent replacement renal therapy due to severe renal impairment (KDIGO stage 3). Multivariable logistic regression analysis (adjusted to risk factors) showed that preoperative estimated glomerular filtration rate (eGFR) was the risk factor for postoperative RRT (odds ratio (OR) = 0.95, 95% Confidence Interval (CI): 0.92–0.97, p < 0.01). Length of hospital and intensive care unit stay were differing between the patients with and without postoperative RRT (p < 0.001 for both). Postoperative RRT was associated with 30-day mortality (10.3% versus 35.7%, p < 0.001). Conclusions: Postoperative renal dysfunction including postoperative RRT was associated with higher morbidity and mortality rate in patients who underwent ATAAD repair under hypothermic circulatory arrest.