The following is the summary of “Proximal aortic repair in dialysis patients: A national database analysis” published in the January 2023 issue of Thoracic and cardiovascular surgery by Ogami, et al.
Having dialysis is a known risk factor for worse outcomes following cardiac surgery. However, results from proximal aortic surgery in this high-risk population are little understood. Therefore, patients with nonruptured thoracic aortic aneurysm (aneurysm, n=325) or type A aortic dissection (dissection, n=461) who underwent open proximal aortic repair between 1987 and 2015 were analyzed for perioperative (in-hospital or 30-day mortality) and 10-year outcomes using the US Renal Data System database.
There was a 12.6% perioperative death rate among aneurysm patients. Over a 10-year period, mortalities were 81% 3%. Worse 10-year mortality was linked with being over the age of 65 (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.03 to 1.78; P=.03), having the chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.01-2.82; P=.047), and being Black (HR, 1.46; 95% CI, 1.09-1.97; P=.01). The perioperative mortality rate for patients with dissection was 24.3%, and the 10-year mortality rate was 87.9% ± 2.2%. In addition, dialysis due to diabetes mellitus (HR, 1.75; 95% CI, 1.2-2.57; P=.004), congestive heart failure (HR, 1.49; 95% CI, 1.19-1.86; P<.001), or age 65 or older were independently related with poorer 10-year mortality.
Results were better for black people (hazard ratio [HR], 0.74; 95% CI, 0.6-0.92; P=.008). In this article, researchers discussed the complicated perioperative and 10-year outcomes for dialysis patients undergoing proximal aortic surgery. The current research supports the viability of emergency surgery for acute type A aortic dissections but implies that cautious patient selection is necessary for elective repair of proximal aortic aneurysms in dialysis-dependent patients.