Renal outcome:
The incidence of AKI in our study population was 67%, which is slightly higher than what is reported in the literature for AAD cases. It is noteworthy to mention though that incidence of new postoperative dialysis (12%) in our study is comparable to the previous literature10-12. This difference could be attributed to the variation in the definition of AKI used in various studies, surgical technique, demographic characteristics, and institutional protocols for the initiation of CVVHD. Ko et al (2015) in their study which included 375 patients reported an incidence of 44.0% AKI out of which 9% required temporary dialysis and further 3% progressed to end-stage renal disease10. They also observed that the mortality and major adverse cardiovascular and cerebrovascular events correlated significantly with the severity of AKI. Extracorporeal circulation time, body mass index, perioperative peak serum C-reactive protein concentration, renal malperfusion, and perioperative sepsis were found to be risk factors for AKI.
Imasaka et al. (2015) in their retrospective review reported an incidence of 15.8% of renal replacement therapy. The proposed risk factors for postoperative renal replacement therapy were estimated glomerular filtration rate, coronary ischemic time, and total arch replacement 11. Sansone et al. (2015) observed a 37.8% incidence of AKI needing CVVHD after type A aortic dissection. Preoperative oliguria, longer Cardiopulmonary bypass /circulatory arrest times, and postoperative bleeding requiring a surgical revision were implicated as the predominant risk factors for the adverse outcome12. Similarly, Ghincea et al. (2019) reported a 32% incidence of AKI following aortic arch surgery. In the multivariable analysis, significant predictors of AKI were history of hypertension and CPB duration13. Kato et al. (2016) reported hypertension, type A aortic dissection, and low platelet levels as risk factors for AKI after aortic dissection surgery22,