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Preoperative renal function affects outcomes of surgery for aortic arch aneurysm in the elderly

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Abstract

Objectives

This study aimed to determine the optimal surgical procedure for arch aneurysm in the elderly based on preoperative comorbidities, especially focusing on renal function.

Methods

The medical records of 374 patients who experienced arch surgery between 2008 and 2019 were reviewed. Among the 374 patients, 92 who underwent total arch replacement (TAR) were assigned to the TAR group and the remaining 152 who underwent debranching thoracic endovascular aortic repair (DTEVAR) were assigned to the DTEVAR group.

Results

Chronic kidney disease (CKD) was an independent risk factor of mortality (hazard ratio, 2.85; p = 0.029) in the TAR group but not in the DTEVAR. In the Grade I/II category CKD (estimated glomerular filtration rate (eGFR) > 60 mL/min), freedom from all-cause mortality was significantly higher in the TAR group than in the DTEVAR group (p = 0.0155, log-rank). Freedom from all-cause mortality was comparable between the two groups in the Grade IIIa CKD (eGFR, 45–60) (p = 0.584, log-lank), Grade IIIb (eGFR, 30–45) (p = 0.822), and Grade IV/V (eGFR < 30) (p = 0.548).

Conclusion

In elderly patients who underwent TAR, CKD was the independent risk factor of the mortality, but not in the patients who underwent debranching TEVAR. Conversion of surgical strategy from TAR to debranching TEVAR in the treatment of aortic arch aneurysms in the elderly with CKD below Grade IIIa is acceptable considering that less-invasiveness. While, in the elderly with Grade I/II CKD, TAR still remains as a primary choice for the arch repair for better mid-term survival.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe Shinmachi, Suita, Osaka, 564-8565, Japan

    Yoshimasa Seike, Koki Yokawa, Yosuke Inoue, Takayuki Shijo, Kyokun Uehara, Hiroaki Sasaki & Hitoshi Matsuda

  2. Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan

    Tetsuya Fukuda

Authors
  1. Yoshimasa Seike
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  2. Koki Yokawa
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  3. Yosuke Inoue
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  4. Takayuki Shijo
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  5. Kyokun Uehara
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  6. Hiroaki Sasaki
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  7. Tetsuya Fukuda
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  8. Hitoshi Matsuda
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Correspondence to Hitoshi Matsuda.

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11748_2020_1550_MOESM1_ESM.tif

Supplementary file1 Supplementary Figure E1. Based on the classification of chronic kidney disease (CKD) using estimated glomerular filtration rate (eGFR), patients were divided into 4 categories: those with Grade I/II CKD (eGFR > 60 mL/min), Grade IIIa (eGFR, 45–60), Grade IIIb (eGFR, 30–45) and Grade IV/V (eGFR < 30), and survival was compared between the two procedures. In Grade I/II category (A), freedom from aorta-related mortality was significantly higher in the total arch replacement group than in the debranching thoracic endovascular aortic repair group (p = 0.0162, log-rank). In Grade IIIa (B) (p = 0.999, log-rank), Grade IIIb (C) (p = 0.935, log-rank) and Grade IV/V (D) (p = 0.156, log-rank), freedom from all-cause mortality was comparable between the 2 subgroups (TIF 2286 KB)

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Seike, Y., Yokawa, K., Inoue, Y. et al. Preoperative renal function affects outcomes of surgery for aortic arch aneurysm in the elderly. Gen Thorac Cardiovasc Surg 69, 1050–1059 (2021). https://doi.org/10.1007/s11748-020-01550-9

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  • DOI: https://doi.org/10.1007/s11748-020-01550-9

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