Early postoperative renal dysfunction predicts long term renal function degradation after type IV thoraco-abdominal aortic aneurysm surgical repair.

Abstract Objectives Type IV thoraco-abdominal aortic aneurysm surgical repair is often complicated by postoperative acute kidney injury. The aim was to evaluate early renal injury influence on long term renal function. Methods All type IV thoraco-abdominal surgical repair performed between January 2000 and January 2014 in our tertiary hospital were included in this retrospective observational study. All procedures were performed through a retro-peritoneal approach with at least supra renal aortic cross clamping. Cold Ringer Lactate was used to perfuse the kidneys. Serum creatinine (Scr.) and glomerular filtration rate (GFR) were recorded preoperatively, daily until discharge and at least annually during follow-up. Postoperative renal dysfunction was classified using the RIFLE score. Predictors of long term renal decline were identified by logistic regression and a cox model. Results 80 patients were included. Aortic clamping level was supra renal (10%), supra-mesenteric (37%) or supra-coeliac (53%). Ischemic durations were: 29±9 min for the gastrointestinal tract and the right kidney, 54±28 min for the left kidney. 3 patients died post operatively. At discharge, 31 (38.8%) patients didn't have a postperative renal impairment (RIFLE-), compared to 49 (61.2%) who had a renal dysfunction (RIFLE+). GFR was 89±29ml/min vs 68±37ml/min, respectively (p Conclusion Postoperative renal dysfunction was a frequent complication, associated with long term renal function degradation.