Outcomes and risk factors of postoperative hepatic dysfunction in patients undergoing acute type A aortic dissection surgery

Wei Zhou; Guokun Wang; Yaoyang Liu; Yun Tao; Zhen Du; Yangfeng Tang; Fan Qiao; Yang Liu; Zhiyun Xu

doi:10.21037/jtd.2019.08.72

Outcomes and risk factors of postoperative hepatic dysfunction in patients undergoing acute type A aortic dissection surgery

J Thorac Dis. 2019 Aug;11(8):3225-3233. doi: 10.21037/jtd.2019.08.72.

Authors

Wei Zhou¹, Guokun Wang¹, Yaoyang Liu², Yun Tao¹, Zhen Du¹, Yangfeng Tang¹, Fan Qiao¹, Yang Liu¹, Zhiyun Xu¹

Affiliations

¹ Department of Cardiovascular Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
² Department of Rheumatology and Immunology, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China.

Abstract

Background: Postoperative hepatic dysfunction (HD) increases the morbidity and mortality risk after cardiac surgery; however, only a few studies have specifically focused on acute type A aortic dissection (AAAD) surgery. We explored the possible risk factors and outcomes of early postoperative HD in patients with AAAD undergoing surgery.

Methods: All patients who underwent AAAD surgery at our institution from April 2015 to April 2017 were retrospectively evaluated. Postoperative model for end-stage liver disease (MELD) score was used to define HD. Independent risk factors for HD were determined by multivariate logistic analysis.

Results: Two hundred fifteen patients with AAAD met the inclusion criteria. The incidence rate of early postoperative HD was 60.9%, and the rate of in-hospital mortality was 16.8%. Patients with a high postoperative MELD score had longer mechanical ventilation time, longer durations of intensive care unit (ICU) stay, and higher in-hospital mortality. During the postoperative period, patients with AAAD complicated by HD needed continuous renal replacement therapy (CRRT), reintubation, tracheostomy, and blood transfusion more frequently. Aortic cross clamp (ACC) time [per 10 min higher; odds ratio (OR): 1.216, 95% confidence interval (CI): 1.017-1.454, P=0.032], postoperative leucocytes (per 2×10⁹/L higher; OR: 1.161, 95% CI: 1.018-1.324, P=0.026), postoperative respiratory dysfunction (OR: 3.176, 95% CI: 1.293-7.803, P=0.012), and postoperative low cardiac output syndrome (LCOS) (OR: 12.663, 95% CI: 1.432-111.998, P=0.022) were independent risk factors associated with HD in patients undergoing AAAD surgery.

Conclusions: Postoperative HD prolongs mechanical ventilation time and ICU stay, and is associated with increased in-hospital mortality among patients who undergo AAAD surgery. Several factors are associated with a high postoperative MELD score.

Keywords: Hepatic dysfunction (HD); acute type A aortic dissection (AAAD); in-hospital mortality; model for end-stage liver disease score (MELD score); multivariate analysis.