Clinical Study Of Acute Stanford Type A Aortic Dissection Complicated With Renal Malperfusion

Objective:Toanalyze the general data,surgical data,early postoperative complications and short-term and long-term prognosis of patients with acute Stanford type A aortic dissection(AAAD)complicated with preoperative renal perfusion failure,and to study the effect of preoperative renal malperfusion on the perioperative and long-term prognosis of AAAD patients.Method:A total of 130 patients who underwent surgical treatment for acute Stanford type A aortic dissection in Sichuan Mianyang 404 Hospital from January 2013 to January 2021 were analyzed retrospectively.There were 98 males(75.38%)and 32 females(24.62%),aged from 34 to 69 years,with an average age of 52.22 ± 7.85 years.Taking the results of preoperative computed tomography angiography(CTA)and laboratory test of aorta as the diagnostic criteria,according to whether acute Stanford type A aortic dissection was complicated with poor renal perfusion before operation,it was divided into two groups.The preoperative complicated with poor renal perfusion was the poor renal perfusion group(n=29),The group without poor renal perfusion before operation was normal renal perfusion group(n=101).The preoperative data,intraoperative data,postoperative data and long-term follow-up information of the patients were counted,and the perioperative data and long-term prognosis of the two groups were compared.Multivariate logistic regression analysis was used to screen the independent risk factors of postoperative hospital death and postoperative acute renal injury(AKI)in patients with acute Stanford type A aortic dissection.The results were expressed by odds ratio(or)and 95%confidence interval(95%CI).Kaplan Meier method was used to describe the postoperative survival curve of the two groups,and log rank test was used for comparison between the two groupsResult:In the comparison of preoperative general data between the two groups,the value of serum creatinine in the group with poor renal perfusion was significantly higher than that in the group with normal renal perfusion(P<0.05);The glomerular filtration rate in the group with poor renal perfusion was significantly lower than that in the group with normal renal perfusion(P<0.05);There was no significant difference in other preoperative general data between the two groups(P>0.05).There was no significant difference in operation time,cardiopulmonary bypass time,aortic occlusion time,circulatory arrest time and operation mode between the two groups(P>0.05).In the comparison of postoperative data between the two groups,the ICU time in the group with poor renal perfusion was longer than that in the group with normal renal perfusion,and the difference was statistically significant(P<0.05);The incidence of postoperative temporary neurological dysfunction,acute renal injury and continuous renal replacement therapy in the group with poor renal perfusion were significantly higher than those in the group with normal renal perfusion(P<0.05);The in-hospital mortality was 37.9%in the group with poor renal perfusion and 15.8%in the group with normal renal perfusion(P<0.05).Multivariate logistic regression analysis showed that preoperative renal perfusion was poor(OR:8.549,95%CI:1.625～45.445,P=0.011),cardiopulmonary bypass time(OR:1.023,95%CI:1.007～1.038,P=0.005),simultaneous coronary artery bypass grafting(OR:7.012,95%CI:1.010～48.694,P=0.049)Poor perfusion of other organs(OR:14.034,95%CI:1.282～153.574,P=0.030)was an independent risk factor for postoperative hospital death;Preoperative poor renal perfusion(OR:4.752,95%CI:1.298～17.390,P=0.019)and extracorporeal circulation time(OR:1.016,95%CI:1.002～1.029,P=0.022)were independent risk factors for AKI after operation.There was no significant difference in postoperative survival curve between the two groups(Log-rank:χ~2=2.557,P=0.110).Conclusion:Preoperative renal malperfusion increased the postoperative ICU time,in-hospital mortality,the incidence of acute renal injury,the rate of continuous renal replacement therapy and the incidence of temporary neurological dysfunction in patients with acute Stanford type A aortic dissection.Preoperative renal malperfusion is an independent risk factor for postoperative hospital death and postoperative acute renal injury in patients with acute Stanford type A aortic dissection.Although poor preoperative renal malperfusion increased the postoperative in-hospital mortality of patients with acute Stanford type A aortic dissection,there was no significant difference in long-term survival between the two groups.Poor preoperative renal malperfusion did not increase the postoperative long-term mortality of patients with acute Stanford type A aortic dissection.