Renal Artery Involvement as a Reliable Indicator of Severe Branch Vessel Involvement and Malperfusion in Type A Aortic Dissection

Background: Reliable indicators to assess the severity and extent of type A aortic dissection (TAAD) remain lacking. This study aimed to evaluate the role of renal artery involvement in this context. Methods: From January 2020 to June 2022, a total of 471 patients with TAAD who underwent open surgical repair were retrospectively analyzed. Based on computed tomography angiography, patients were categorized into two groups: those with renal involvement (RAI, n=289) and those without (non-RAI, n=182). To further validate the results, propensity score matching (PSM) was performed to minimize bias. A multivariate ordered logistic regression model was used to evaluate the association between renal involvement and the number of end-organ malperfusion. The incidence of dialysis dependence was calculated using the Kaplan-Meier method. Cox regression models were utilized to determine factors of overall and mid-term mortality. Results: The RAI group exhibited more extensive aortic branch involvement (all P<0.05) and required more concomitant branch procedures, with a higher incidence of end-organ malperfusion (P=0.006), as well as increased serious adverse events (P=0.009), which remain consistent after PSM matching. The multivariate ordered logistic regression model indicated that renal involvement was associated with malperfusion [Odds ratio=2.00, 95% confidence interval (CI):1.25-3.27]. Multivariable Cox regression analysis identified renal involvement as an independent risk factor for overall mortality [hazard ratio (HR)=3.48, 95%CI:1.15-10.47, P=0.027] and mid-term mortality (HR=3.42, 95%CI:1.14-10.31, P=0.029). Kaplan-Meier analysis revealed no significant difference in dialysis dependence. Conclusions: Renal artery involvement signifies more severe aortic branch compromise and malperfusion, and worse prognosis.