Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort study

Type A aortic dissection (TAAD) is a severe cardiovascular condition associated with high risks for postoperative complications, particularly renal dysfunction. This study investigated whether intraoperative hypotension and venous congestion are important predictors of postoperative kidney injury and major adverse events. We retrospectively analyzed 543 adults undergoing TAAD surgery (2016–2023). Primary outcomes were acute kidney injury (AKI) and acute kidney disease (AKD). Secondary outcomes included death, stroke and composite outcome. Patients were divided into four groups: AKI only, AKD only, AKI and AKD, Non-AKI or AKD. We used restricted cubic spline and multivariate logistic regression models to adjust for confounding factors. AKI or AKD was significantly associated with each 10-minute epoch of central venous pressure (CVP) ≥10, 12, 16, 20 mmHg (all p p ≤ 0.003), a 5% to 21% increase for each 60-minute epoch of CVP ≥10, 12, 16, 20 mmHg AUC (all p p = 0.039 and p = 0.031, respectively). Elevated CVP and lower MAP levels were linked to postoperative AKI and AKD risk. CVP showed stronger associations with mortality and stroke. Optimizing perioperative hemodynamic management may improve individualized interventions. Acute kidney injury and acute kidney disease are common and serious complications after Type A aortic dissection surgery.This observational cohort study showed that both intraoperative venous congestion and hypotension are associated with acute kidney injury and acute kidney disease. In addition intraoperative venous congestion displayed a direct correlation with postoperative outcomes such as death and stroke. Acute kidney injury and acute kidney disease are common and serious complications after Type A aortic dissection surgery. This observational cohort study showed that both intraoperative venous congestion and hypotension are associated with acute kidney injury and acute kidney disease. In addition intraoperative venous congestion displayed a direct correlation with postoperative outcomes such as death and stroke.