Skip to main content

Advertisement

SpringerLink
Log in

Surgical outcomes of acute type A aortic dissection in dialysis patients

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, Wakai K, Wada A, Nitta K. Annual dialysis data report 2014, JSDT renal data registry (JRDR). Ren Replace Ther. 2017;3:18.

    Article  Google Scholar 

  2. Hanafusa N, Nakai S, Iseki K, Tsubakihara Y. Japanese society for dialysis therapy renal data registry—a window through which we can view the details of Japanese dialysis population. Kidney Int Suppl (2011). 2015;5:15–22.

    Article  Google Scholar 

  3. Ziganshi BA, Theodoropoulos P, Salloum MN, Zaza KJ, Tranquilli M, Mojibian HR et al. Simple renal cysts as markers of thoracic aortic disease. J Am Heart Assoc. 2016;5:e002248.

    Google Scholar 

  4. Perrone RD, Malek AM, Watnick T. Vascular complications in autosomal dominant polycystic kidney disease. Nat Rev Nephrol. 2015;11:589–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Fukunaga N, Yuzaki M, Nasu M, Okada Y. Dissecting aneurysm in a patient with autosomal dominant polycystic kidney disease. Ann Thorac Cardiovasc Surg. 2012;18:375–8.

    Article  PubMed  Google Scholar 

  6. Sung PH, Yang YH, Chiang HJ, Chiang JY, Chen CJ, Liu CT, et al. Risk of aortic aneurysm and dissection in patients with autosomal-dominant polycystic kidney disease: a nationwide population-based cohort study. Oncotarget. 2017;8:57594–604.

    PubMed  PubMed Central  Google Scholar 

  7. Rahmanian PB, Adams DH, Castillo JG, Vassalotti J, Filsoufi F. Early and late outcome of cardiac surgery in dialysis-dependent patients: single-center experience with 245 consecutive patients. J Thorac Cardiovasc Surg. 2008;135:915–22.

    Article  PubMed  Google Scholar 

  8. Hori D, Yamaguchi A, Adachi H. Coronary artery bypass surgery in end-stage renal disease patients. Ann Vasc Dis. 2017;10:79–87.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liang NL, Yuo TH, Al-Khoury GE, Hager ES, Makaroun MS, Singh MJ. High mortality rates after both open surgical and endovascular thoracic aortic interventions in patients with end-stage renal disease. J Vasc Surg. 2017;66:991–6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Committee for Scientific Affairs The Japanese Association for Thoracic Surgery, Masuda M, Okumura M, Doki Y, Endo S, Hirata Y, et al. Thoracic and cardiovascular surgery in Japan during 2014: annual report by the japanese association for thoracic surgery. Gen Thorac Cardiovasc Surg. 2016;64:665–697.

    Article  PubMed Central  Google Scholar 

  11. Okita Y. Current surgical results of acute type A aortic dissection in Japan. Ann Cardiothorac Surg. 2016;5:368–76.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dhanani J, Mullany DV, Fraser JF. Effect of preoperative renal function on long-term survival after cardiac surgery. J Thorac Cardiovasc Surg. 2013;146:90–5.

    Article  PubMed  Google Scholar 

  13. Itagaki R, Kimura N, Mieno M, Hori D, Itoh S, Akiyoshi K, et al. Characteristics and treatment outcomes of acute type A aortic dissection with elevated d-dimer concentration. J Am Heart Assoc. 2018;7:e009144.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sasabuchi Y, Kimura N, Shiotsuka J, Komuro T, Mouri H, Ohnuma T, et al. Long-term survival in patients with acute kidney injury after acute type A aortic dissection repair. Ann Thorac Surg. 2016;102:2003–9.

    Article  PubMed  Google Scholar 

  15. Aizawa K, Kawahito K, Misawa Y. Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection. Gen Thorac Cardiovasc Surg. 2016;64:403–8.

    Article  PubMed  Google Scholar 

  16. Lawton JS, Liu J, Kulshrestha K, Moon MR, Damiano RJ Jr, Maniar H, et al. The impact of surgical strategy on survival after repair of type A aortic dissection. J Thorac Cardiovasc Surg. 2015;150:294 e291–301 e291.

    Google Scholar 

  17. Etz CD, von Aspern K, da Rocha ESJ, Girrbach FF, Leontyev S, Luehr M, et al. Impact of perfusion strategy on outcome after repair for acute type a aortic dissection. Ann Thorac Surg. 2014;97:78–85.

    Article  PubMed  Google Scholar 

  18. Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A, et al. Predicting death in patients with acute type A aortic dissection. Circulation. 2002;105:200–6.

    Article  PubMed  Google Scholar 

  19. Goda M, Imoto K, Suzuki S, Uchida K, Yanagi H, Yasuda S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg. 2010;90:1246–50.

    Article  PubMed  Google Scholar 

  20. Yamauchi T, Miyata H, Sakaguchi T, Miyagawa S, Yoshikawa Y, Takeda K, et al. Coronary artery bypass grafting in hemodialysis-dependent patients. Circ J. 2012;76:1115–20.

    Article  PubMed  Google Scholar 

  21. Okada K, Omura A, Kano H, Nakai H, Miyahara S, Minami H, et al. Outcome of elective total aortic arch replacement in patients with non-dialysis-dependent renal insufficiency stratified by estimated glomerular filtration rate. J Thorac Cardiovasc Surg. 2014;147:966 e962–72 e962.

    Article  Google Scholar 

  22. de Jong PA, Hellings WE, Takx RA, Isgum I, van Herwaarden JA, Mali WP. Computed tomography of aortic wall calcifications in aortic dissection patients. PLoS One. 2014;9:e102036.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Uchida N, Katayama A, Tamura K, Sutoh M, Kuraoka M, Ishihara H. Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection. Eur J Cardiothorac Surg. 2011;40:1066–71.

    PubMed  Google Scholar 

  24. Conzelmann LO, Hoffmann I, Blettner M, Kallenbach K, Karck M, Dapunt O, et al. GERAADA Investigators. Analysis of risk factors for neurological dysfunction in patients with acute. aortic dissection type A: data from the German Registry for Acute Aortic Dissection type A (GERAADA). Eur J Cardiothorac Surg. 2012;42:557–65.

    Article  PubMed  Google Scholar 

  25. Juraszek A, Bayer G, Dziodzio T, Kral A, Laufer G, Ehrlich M. Evaluation of the intraoperative specimens of the thoracic and abdominal aorta. J Cardiothorac Surg. 2013;8:110.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.

    Article  PubMed  Google Scholar 

  27. Tamura K, Sugisaki Y, Kumazaki T, Tanaka S. Atherosclerosis-related aortic dissection. Kyobu Geka. 2000;53:194–201.

    CAS  PubMed  Google Scholar 

  28. Nakashima Y, Kurozumi T, Sueishi K, Tanaka K. Dissecting aneurysm: a clinicopathologic and histopathologic study of 111 autopsied cases. Hum Pathol. 1990;21:291–6.

    Article  CAS  PubMed  Google Scholar 

  29. Plonek T, Zak M, Rylski B, Berezowski M, Czerny M, Beyersdorf F, et al. Wall stress correlates with intimal entry tear localization in type A aortic dissection. Interact Cardiovasc Thorac Surg. 2018;27:797–801.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Dr. Makiko Mieno (Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan) for her technical assistance with the different statistical methods.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanumacho, Omiya-ku, Saitama, 330-8503, Japan

    Kei Akiyoshi, Naoyuki Kimura, Daijiro Hori, Homare Okamura, Hideki Morita, Koichi Adachi, Koichi Yuri & Atsushi Yamaguchi

  2. Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan

    Kei Aizawa & Koji Kawahito

Authors
  1. Kei Akiyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoyuki Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kei Aizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daijiro Hori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Homare Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideki Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koichi Adachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Koichi Yuri
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Koji Kawahito
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Atsushi Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naoyuki Kimura.

Ethics declarations

Conflict of interest

Kei Akiyoshi and the other authors have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Akiyoshi, K., Kimura, N., Aizawa, K. et al. Surgical outcomes of acute type A aortic dissection in dialysis patients. Gen Thorac Cardiovasc Surg 67, 501–509 (2019). https://doi.org/10.1007/s11748-018-1051-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-018-1051-6

Keywords

Search

Navigation