Key result
Preoperative moderate/severe pericardial effusion significantly increased the risk of severe adverse outcomes (OR 11.645) in patients with postoperative hepatic dysfunction following total arch repair for acute type A aortic dissection.
Why the study?
To investigate the incidence and outcomes of postoperative hepatic dysfunction after total arch repair of acute type A aortic dissection, and identify risk factors for severe adverse outcomes.
Cohort (n=227)
No
Odds Ratio: 11.645 (95% CI 1.144–143.617)
p-value: p=0.045
Postoperative hepatic dysfunction is a common complication after total arch repair for acute type A aortic dissection and is associated with high morbidity and mortality, with risk exacerbated by preoperative pericardial effusion, celiac trunk involvement, prolonged bypass time, and low postoperative albumin.
BACKGROUND: This study was aimed to investigate the incidence and outcomes of patients with postoperative hepatic dysfunction (PHD) after total arch repair of acute type A aortic dissection, and further explore the risk factors for severe adverse outcomes. METHODS: The clinical data of 227 patients with AAAD treated by modified triple-branched stent graft implantation from January 2020 to January 2021 were collected retrospectively. Including preoperative, surgical and postoperative data. Logistics regression was used to determine the independent risk factors of severe adverse outcomes in postoperative HD patients. RESULTS: In the early stage after operation, a total of 153 patients were complicated with PHD, accounting for 67.4%. The incidence of severe adverse outcomes in patients with PHD was 43.1%. We found that preoperative moderate/severe pericardial effusion [odds ratio (OR): 11.645, 95% confidence interval (CI): 1.144, 143.617, P = 0.045], preoperative imaging data suggest the celiac trunk involvement [OR: 6.136, 95% CI 1.019, 36.930, P = 0.048], CPB time > 180 min [OR: 4.855, 95% CI 1.218, 15.761, P = 0.034], decreased early postoperative serum albumin [OR: 0.935, 95% CI 0.856, 0.985, P = 0.026] were independent risk factors for severe adverse outcomes in patients with PHD. CONCLUSIONS: PHD was associated with increased early mortality and morbidity. Preoperative moderate/severe pericardial effusion, preoperative celiac trunk involvement, cardiopulmonary bypass (CPB) time > 180 min and decreased early postoperative serum albumin were identified as independent risk factors for severe adverse outcomes in patients with PHD.
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Lin et al. (2022) conducted a cohort in Acute type A aortic dissection (n=227). Preoperative moderate/severe pericardial effusion vs. Absence of moderate/severe pericardial effusion was evaluated on Severe adverse outcomes in patients with postoperative hepatic dysfunction (OR 11.645, 95% CI 1.144-143.617, p=0.045). Preoperative moderate/severe pericardial effusion significantly increased the risk of severe adverse outcomes (OR 11.645) in patients with postoperative hepatic dysfunction following total arch repair for acute type A aortic dissection.
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