Abstract 2129: Ascending and Transverse Aortic Arch Repair: The Impact of Glomerular Filtration Rate on Mortality
Objective: Recent studies have described the importance of renal glomerular filtration rate (GFR) as a determinant of perioperative mortality in patients with aneurysms that involve the thoracoabdominal and abdominal aorta. We studied the impact of GFR on mortality following repair of ascending and arch aneurysms.
Methods: Between February 1991 and July 2005, we performed 880 repairs of the ascending and transverse aortic arch. 710 patients had evaluable data for this study. 63% were men (447/710); mean age was 62 ± 15. We estimated the GFR using the Cockcroft-Gault equation. Mean preoperative serum creatinine was 1.2 ± 0.9 mg/dl, mean GFR was 77 ± 37 cc/min. Renal function data were arrayed in quartiles for univariate analysis and kept continuous for multivariable analyses. Multivariable analyses assessed demographics, extent of disease, acuity of presentation, and renal function measured by both creatinine and GFR.
Results: Overall 30-day mortality was 10.9% (78/710). In univariate analyses, GFR (p<0.0001), serum creatinine (p<0.0003), acute dissection (p<0.03), emergency presentation (p<0.002) and age (p<0.009) were associated with increased mortality. By multivariable analyses, only GFR (p<0.0001) and acute dissection (p<0.04) were significant independent risk factors for mortality
Conclusions: Preoperative renal function as defined by GFR was the most significant predictor of mortality during repairs of the ascending and transverse aortic arch. The use of GFR provides better preoperative risk stratification during these repairs than creatinine alone.