Surgical outcomes of acute type A aortic dissection in dialysis patients

• Published in: General thoracic and cardiovascular surgery 2019-06, Vol.67 (6), p.501-509
• Main Authors: Akiyoshi, Kei, Kimura, Naoyuki, Aizawa, Kei, Hori, Daijiro, Okamura, Homare, Morita, Hideki, Adachi, Koichi, Yuri, Koichi, Kawahito, Koji, Yamaguchi, Atsushi
• Format: Article
• Language: English
• Subjects: Aortic dissection; Calcification; Cardiac Surgery; Cardiology; Coronary vessels; Hemodialysis; Hospitals; Hypertension; Ischemia; Kidney diseases; Marfan syndrome; Medicine; Medicine & Public Health; Original Article; Patients; Peritoneal dialysis; Surgery; Surgical Oncology; Surgical outcomes; Thoracic Surgery; Veins & arteries
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-018-1051-6

Background Acute type A aortic dissection (ATAAD) is relatively uncommon in dialysis patients, and characteristics and repair outcomes are not fully understood. Patients and methods Patients with ATAAD ( n  = 960) were divided into a dialysis group ( n  = 19) and non-dialysis group ( n  = 941), depending on whether they required dialysis for preoperative end-stage renal disease (ESRD). Hospital charts and imaging data were reviewed, and characteristics and outcomes were compared between the groups. Segmental aortic wall or intima/media flap calcification in the thoracic and abdominal aorta was assessed in the dialysis patients. Results The leading primary causes of ESRD were polycystic kidney disease ( n  = 5) and chronic glomerulonephritis ( n  = 5). There were no significant differences (dialysis group vs. non-dialysis group) in age (60.5 vs. 64.5 years), preoperative hemodynamics, or organ ischemia. Dialysis patients were more likely to have an entry tear in the aortic arch (42% vs. 15%, p  = 0.003). These patients showed moderate-to-severe calcification (multiple focal or single focal calcification > 10 mm) in the ascending aorta (17%), aortic arch (61%), descending aorta (67%), and abdominal aorta (83%). Arch replacement was common in this group (37% vs. 18%, p  = 0.030). Although in-hospital mortality was increased in this group (21% vs. 7%, p  = 0.059), morbidities did not differ significantly. Six-year survival was 60.3 ± 13.4% and 78.8 ± 1.6%, respectively ( p  = 0.01). Conclusions Dialysis patients tend to have aortic calcification and a primary tear in the aortic arch. Outcomes are acceptable.