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Hepatic dysfunction in patients who received acute DeBakey type I aortic dissection repair surgery: incidence, risk

Zhigang Wang1, Min Ge1, Cheng Chen1

  • 1Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.

Journal of Cardiothoracic Surgery
|October 11, 2021
PubMed

Insights

Hepatic dysfunction is common after acute DeBakey type I aortic dissection repair, increasing 30-day mortality. Lower fibrinogen, higher creatinine, and longer bypass/ventilation times predict this complication.

Area of Science:

  • Cardiology
  • Hepatology
  • Surgical Outcomes

Background:

  • Hepatic dysfunction (HD) significantly increases morbidity and mortality following cardiac surgery.
  • Limited research exists on the association between HD and acute DeBakey type I aortic dissection (ADIAD) surgery.
  • This study investigates risk factors for HD post-ADIAD repair and its consequences.

Purpose of the Study:

  • Identify independent risk factors for developing postoperative hepatic dysfunction in patients undergoing ADIAD repair.
  • Analyze the impact of HD on 30-day and long-term survival after ADIAD surgery.
  • Provide insights into managing and preventing HD in this patient population.

Main Methods:

  • Retrospective analysis of 634 patients undergoing ADIAD repair (January 2014 - December 2019).
  • Hepatic dysfunction defined by an End-Stage Liver Disease (MELD) score > 14.
  • Logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards regression were employed.

Main Results:

  • Postoperative HD occurred in 63.2% of patients, with a 15.5% 30-day mortality rate.
  • Independent risk factors for HD included lower preoperative plasma fibrinogen level (PFL), higher serum creatinine (sCr) on admission, longer cardiopulmonary bypass (CPB) time, and extended postoperative mechanical ventilation (MV) duration.
  • Kaplan-Meier analysis showed a significant difference in long-term survival between patients with and without HD, though hazard ratios were not significant.

Conclusions:

  • Hepatic dysfunction is a frequent complication after ADIAD surgery, correlating with increased 30-day mortality.
  • Preoperative low PFL, elevated sCr, prolonged CPB, and longer MV are key independent risk factors for postoperative HD.
  • Understanding these risk factors can aid in risk stratification and management strategies for ADIAD patients.
Abstract

Keywords:
DeBakey type I aortic dissectionHepatic dysfunctionModel for end-stage liver disease scoreMultivariate analysis

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