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,