Preoperative Renal Function Strongly Predicts Postoperative Outcomes in Aortic Arch Surgery with Circulatory Arrest

OBJECTIVES: To evaluate the impact of preoperative renal function on early clinical outcomes of patients undergoing aortic arch surgery with hypothermic circulatory arrest and visceral ischaemia. METHODS: This single-centre retrospective study included 1077 consecutive patients who underwent aortic arch surgery between 1996 and 2024 at the University Hospital of Bologna. Patients were stratified by preoperative estimated glomerular filtration rate into 4 stages. Regression analysis, including adjustment for confounders and cubic splines, was applied to assess the impact of estimated glomerular filtration on 30-day mortality and major complications. RESULTS: A lower estimated glomerular filtration value was significantly associated with increased 30-day mortality (-0.015; CI: -0.025; -0.005), prolonged intubation (-0.018; CI: -0.024; -0.012), higher incidence of temporary dialysis (-0.021; CI: -0.032; -0.011), and gastrointestinal complications (-0.014; CI: -0.025; -0.003) in univariate logistic regression models, and after adjustment for confounders these associations remained significant. CONCLUSIONS: Preoperative renal function is a powerful predictor of early morbidity and mortality following aortic arch surgery. The preoperative estimated glomerular filtration value is a key factor in surgical risk stratification and the development of tailored intraoperative strategies.