Outcomes And Risk Factors Of Postoperative Hepatic Dysfunction In Patients Undergoing Acute Type A Aortic Dcissection Surgery

【Objective】This study was carried out according to the database of aortic dissection from our hospital cardiac surgery,we retrospectively analyzed clinical data of patients suffered acute type A aortic dissection(ATAAD)in our center from April 2014 to April 2016.the characteristics and epidemiology of ATAAD were analyzed,and explored the outcome and related risk factors of postoperative hepatic dysfunction in ATAAD patients,in order to provide reference and basis for the treatment and outcome of hepatic dysfunction(HD)in patients undergoing ATAAD surgery.【Methods】1.Clinical analysis of ATAAD(1)Subjects were selected according to the clinical database of aortic dissection patients in our center.(2)Analyze sex composition,age distribution and incidence characteristics of the patients.(3)Analyze patient’s preoperative laboratory examination and cardiac ultrasonography.2.Predictors and outcome of hepatic dysfunction in patients undergoing acute Type A aortic dissection surgery(1)To analyze the advantages and disadvantages of different assessment tools for hepatic dysfunction(2)MELD was selected as the tooling to judge whether patients suffer hepatic dysfunction after surgery.(3)Divide patients into high-score group(≥14),HD group and normal group(<14)according to Model for End-stage Liver Disease(MELD).(4)Compare the data of two groups and statistically analyze to obtain clinical results.(5)Multivariate regression analysis was performed to determine the independent risk factors in patients undergoing ATAAD surgery.【Results】1.Clinical analysis of ATAAD(1)A total of 215 ATAAD patients were included in study,all the patients were treated by surgery,the peak age of onset is between 40-60 years old,and the ratio of male to female is 4.2:1(174:41),61.8%of the patients had a history of hypertension before surgery,but only 25%of the patients had normal blood pressure control.(2)The majority of patients had aortic dissection located in the ascending aorta(43%)and arch(36%),a few in the aortic root(21%),About 30%(66/215)of patients with median-gravity peritoneal effusion,21.8%(47/215)of patients with dissection involving the celiac trunk artery,12%(26/215)of patients with superior mesenteric artery,and 12%(26/215)of patients with renal artery involvement.(3)In this study,all patients underwent emergency thoracotomy,with an average onset time of 32h(20-60h)and a postoperative mortality of 10.7%(23/215).2.Related risk factors and outcome of hepatic dysfunction in patients undergoing acute Type A aortic dissection surgery(1)Expound four classification methods for clinical to evaluate hepatic dysfunction:1)biochemical examination;2),Child-Turcotte(CT)score;3),Child-Turcotte-Pugh(CTP)score;4,Model for end-stage Liver Disease(MELD)score.(2)Model for end-stage Liver Disease(MELD)score was selected to evaluate postoperative hepatic dysfunction according to recent studies,215 patients were divided into the hepatic dysfunction group(≥14)and the normal group(<14).(3)According to MELD score,a total of 131 patients included in the hepatic dysfunction group.Postoperative mortality of patients with hepatic dysfunction was 16.8%(22/131),In addition,the patients required more mechanical ventilation time,the ICU retained longer,the probability of re-intubation,tracheotomy and the need for CRRT treatment was higher than the normal group,and the amount of blood transfusion during hospitalization was higher.(4)Multivariate regression analysis showed that the duration of intra-operative circulatory arrest(per 10 minutes)(OR:1.2,95%CI:1.0-1.4,P=0.008),postoperative high WBC(per 2×10~9/L higher)(OR:1.3,95%CI:1.1-1.4,P=0.000),postoperative low cardiac output syndrome OR:5.0,95%CI:2.2-11.2,P=0.000)and respiratory dysfunction(OR:16.9,95%CI:2.0-140.0,P=0.009)were independent risk factors for hepatic dysfunction after ATAAD surgery.【Conclusions】1.Consistent with the results reported in previous literatures,the incidence of ATAAD is mainly male,and the age distribution is middle and old people,and the main reason is poor control of hypertension.2.Hepatic dysfunction after ATAAD surgery affects the prognosis of patients,and is closely related to the mortality rate in hospital.3.Previous high respected risk factors such as peritoneal artery involvement and onset time to surgery were not confirmed as the independent risk factors for hepatic dysfunction after surgery.4.The operative mortality of ATAAD patients is still high,and the in-patient mortality of patients with hepatic dysfunction is significantly increased.Careful surgical management,reduction of extracorporeal circulation(CPB)time,especially ACC time,and active postoperative management of inflammatory reactions,respiratory dysfunction and low cardiac output syndrome can improve patients’prognosis and postoperative survival.