Preoperative renal function affects outcomes of surgery for aortic arch aneurysm in the elderly
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ORIGINAL ARTICLE
Preoperative renal function affects outcomes of surgery for aortic arch aneurysm in the elderly Yoshimasa Seike1 · Koki Yokawa1 · Yosuke Inoue1 · Takayuki Shijo1 · Kyokun Uehara1 · Hiroaki Sasaki1 · Tetsuya Fukuda2 · Hitoshi Matsuda1 Received: 11 September 2020 / Accepted: 7 November 2020 © The Japanese Association for Thoracic Surgery 2020
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
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