Effect of Renal Recovery on Long-Term Survival After Aortic Arch Surgery
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0121
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Nicolas Chanes (1), Ananya Shah (1), William Riley Keeler (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Nicolas Chanes
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University of Colorado Anschutz
University of Colorado Anschutz
Ananya Shah
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University of Colorado Anschutz
University of Colorado Anschutz
William Riley Keeler
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University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
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University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
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University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective:
Acute kidney injury (AKI) after aortic arch surgery remains common, causing significant increases in other morbidity and mortality and length of hospital stay. Despite this, even in severe cases of AKI requiring dialysis, some patients will have renal recovery. However, approximately how many patients will have renal recovery, contributing factors to whether patients will have renal recovery, and subsequent impact on long-term mortality are unknown. We sought to further investigate patients who suffer AKI requiring hemodialysis after aortic arch surgery who survive their initial hospital stay, and to determine how many patients have renal recovery, any contributing factors, and the impact of renal recovery or lack thereof on long term mortality.
Methods:
A single center retrospective aortic database was reviewed for all aortic arch procedures from 2011-2023, totally 944 aortic procedures. Patients were filtered for whether they developed acute renal failure post-operatively requiring hemodialysis. Patients that suffered in-hospital mortality were not included in subsequent analysis.
Among surviving patients, they were split into two cohorts: no renal recovery (NR) or renal recovery (RR). Between groups analysis was performed for pre-operative, operative, and post-operative variables, including long term mortality. Additionally, an adjusted Cox proportional hazard model for post-discharge mortality was performed between the two groups.
Results:
In total, 49 patients were identified who had renal failure requiring hemodialysis after aortic arch surgery. Of these patients, 24 (49.0%) suffered in-hospital mortality. Of the remaining 25 patients, 20 (80.0%) patients had subsequent renal recovery. 11 (55.0%) had renal recovery prior to discharge, with the remaining 9 having renal recovery within 3 months of discharge.
Analysis between the NR and RR cohorts of pre-operative, operative and in-hospital postoperative variables demonstrated no significant differences, apart from notably a lower pre-operative creatinine in the NR cohort (p=0.014), although the sample size was small. Notably, after discharge all patients in the NR recovery cohort died within one year (median 177, IQR 146-225), with only one death in the RR cohort (p<0.001).
Conclusions:
In-hospital mortality is common among patients who require renal replacement therapy after aortic arch surgery. If able to survive their post-operative course, most patients will have recovery of their kidney function. However, patients that do not recover kidney function have an absolute risk of mortality within the first year. These findings may help to guide patients who suffer severe acute kidney failure on their overall prognosis after initial surgical recovery.
Acute kidney injury (AKI) after aortic arch surgery remains common, causing significant increases in other morbidity and mortality and length of hospital stay. Despite this, even in severe cases of AKI requiring dialysis, some patients will have renal recovery. However, approximately how many patients will have renal recovery, contributing factors to whether patients will have renal recovery, and subsequent impact on long-term mortality are unknown. We sought to further investigate patients who suffer AKI requiring hemodialysis after aortic arch surgery who survive their initial hospital stay, and to determine how many patients have renal recovery, any contributing factors, and the impact of renal recovery or lack thereof on long term mortality.
Methods:
A single center retrospective aortic database was reviewed for all aortic arch procedures from 2011-2023, totally 944 aortic procedures. Patients were filtered for whether they developed acute renal failure post-operatively requiring hemodialysis. Patients that suffered in-hospital mortality were not included in subsequent analysis.
Among surviving patients, they were split into two cohorts: no renal recovery (NR) or renal recovery (RR). Between groups analysis was performed for pre-operative, operative, and post-operative variables, including long term mortality. Additionally, an adjusted Cox proportional hazard model for post-discharge mortality was performed between the two groups.
Results:
In total, 49 patients were identified who had renal failure requiring hemodialysis after aortic arch surgery. Of these patients, 24 (49.0%) suffered in-hospital mortality. Of the remaining 25 patients, 20 (80.0%) patients had subsequent renal recovery. 11 (55.0%) had renal recovery prior to discharge, with the remaining 9 having renal recovery within 3 months of discharge.
Analysis between the NR and RR cohorts of pre-operative, operative and in-hospital postoperative variables demonstrated no significant differences, apart from notably a lower pre-operative creatinine in the NR cohort (p=0.014), although the sample size was small. Notably, after discharge all patients in the NR recovery cohort died within one year (median 177, IQR 146-225), with only one death in the RR cohort (p<0.001).
Conclusions:
In-hospital mortality is common among patients who require renal replacement therapy after aortic arch surgery. If able to survive their post-operative course, most patients will have recovery of their kidney function. However, patients that do not recover kidney function have an absolute risk of mortality within the first year. These findings may help to guide patients who suffer severe acute kidney failure on their overall prognosis after initial surgical recovery.
Aortic Symposium:
Aortic Arch
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