What is the clinical evidence from this study?

Study design: Cohort. Population: Hepatic dysfunction after open ascending aortic surgery (n=335). Intervention: Open ascending aortic surgery. Primary outcome: Postoperative hepatic dysfunction (HD) predictive model performance (AUC 0.803, 95% CI 0.754-0.851, p=<0.001).

What does this research mean for the field?

Postoperative hepatic dysfunction (HD) occurs in 66.6% of patients after open ascending aortic surgery and is associated with prolonged ICU and hospital stays, as well as increased risk of complications, although it does not affect in-hospital mortality. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Analyze prognosis and identify major risk factors for hepatic dysfunction after open ascending aortic surgery.

February 12, 2026Journal of Cardiac Surgery0 citationsOpen Access

The Prognosis and Risk Factors for Postoperative Hepatic Dysfunction After Open Ascending Aortic Surgery

Q: What are the key findings of this study?

Open ascending aortic surgery was associated with a 66.6% incidence of postoperative hepatic dysfunction, which could be predicted by a risk factor model with an AUC of 0.803 (95% CI 0.754-0.851).

Q: What does this research mean for the field?

Postoperative hepatic dysfunction (HD) occurs in 66.6% of patients after open ascending aortic surgery and is associated with prolonged ICU and hospital stays, as well as increased risk of complications, although it does not affect in-hospital mortality. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

Analyze prognosis and identify major risk factors for hepatic dysfunction after open ascending aortic surgery.

XZXiaoyu Zhou XLXinzhi Liu MWM H Wang

Key Result

Open ascending aortic surgery was associated with a 66.6% incidence of postoperative hepatic dysfunction, which could be predicted by a risk factor model with an AUC of 0.803 (95% CI 0.754-0.851).

Key Points

Analyze prognosis and identify major risk factors for hepatic dysfunction after open ascending aortic surgery.
Conducted retrospective analysis on patients undergoing open ascending aortic surgery.
Analyzed perioperative clinical data and defined postoperative hepatic dysfunction using peak MELD‐XI values.
Utilized univariate and multivariate binary logistic regression to identify risk factors.
Evaluated predictive model using Receiver Operating Characteristic (ROC) curve and plotted a nomogram.
223 out of 335 patients (66.6%) were diagnosed with postoperative hepatic dysfunction.
HD patients experienced prolonged ICU and hospital stays and a higher risk of complications like hyperbilirubinemia and kidney injury.
Key independent risk factors included gender, BMI, aortic cross‐clamp time, preoperative HD, and intraoperative red blood cell transfusion volume.
The predictive model showed an AUC of 0.803 with 74.4% sensitivity and 75.9% specificity.

Study Design

Type

Cohort (n=335)

Multicenter

Structured PICO

What are the risk factors and prognosis for postoperative hepatic dysfunction in patients undergoing open ascending aortic surgery?

Population

335 patients with ascending aortic disease confirmed by CTA and transthoracic echocardiography who met surgical criteria and underwent open ascending aortic surgery under cardiopulmonary bypass, median age 56, 37.9% female, based in China. Excluded patients with pre-existing severe liver disease or perioperative death within 24 hours.

Intervention

Open ascending aortic surgery under cardiopulmonary bypass

Outcome

Postoperative hepatic dysfunction (HD) defined based on the peak MELD-XI value ≥11 recorded at any time during the first 7 postoperative dayssafety

The MELD-XI score effectively identifies postoperative hepatic dysfunction after open ascending aortic surgery, which is a common complication driven by factors such as female sex, BMI, cross-clamp time, preoperative hepatic dysfunction, and RBC transfusion volume.

Main Result

Effect estimate: AUC 0.803 (95% CI 0.754-0.851)

p-value: p=<0.001

Limitations

Larger studies are needed for further validation in the future

Abstract

Objective The prognosis and risk factors of hepatic dysfunction (HD) after open ascending aortic surgery are not well defined. This study aims to analyze the prognosis and identify the major risk factors for patients with HD after open ascending aortic surgery. Methods A retrospective analysis was conducted on patients who underwent open ascending aortic surgery at Shandong First Medical University Affiliated Shandong Provincial Hospital from June 2019 to June 2021. Perioperative clinical data were analyzed, and postoperative HD was defined based on the peak MELD‐XI value recorded at any time during the first 7 postoperative days. Univariate and multivariate binary logistic regression was used to identify risk factors and develop a predictive model, which was then evaluated with the Receiver Operating Characteristic (ROC) curve and plotted with nomogram. Results Of the 335 patients, 223 (66.6%) were diagnosed with postoperative HD. HD patients had prolonged ICU and hospital stays and a higher risk of hyperbilirubinemia, liver failure, kidney injury, and other complications. However, HD did not affect in‐hospital mortality. Independent risk factors for postoperative HD included gender ( p = 0.014), BMI ( p = 0.022), aortic cross‐clamp time ( p = 0.007), preoperative HD ( p < 0.001), and intraoperative red blood cell transfusion volume ( p < 0.001). The area under the curve (AUC) was 0.803 ( p < 0.001, 95% CI: 0.754–0.851), with a sensitivity of 74.4% and a specificity of 75.9%. Conclusions The MELD‐XI score is a reliable tool for diagnosing HD after open ascending aortic surgery, particularly for patients on warfarin postoperatively. Postoperative HD following open ascending aortic surgery is common and associated with worse outcomes, although it does not affect in‐hospital mortality. The identified risk factors and predictive model provide a valuable tool for prevention and management of postoperative HD. Larger studies are needed for further validation in the future.

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