Analysis of Prognosis and Risk Factors for Postoperative Hepatic Dysfunction in Patients with Acute Type A Aortic Dissection

BACKGROUND: To explore the prognosis and risk factors of postoperative hepatic dysfunction in patients with acute type A aortic dissection. METHODS: A total of 156 patients who underwent surgery for acute type A aortic dissection in our hospital from May 2014 to May 2018 were retrospectively enrolled. The patients were divided into 2 groups based on postoperative liver function. The postoperative model for end-stage liver disease score was used to define hepatic dysfunction. There were 35 patients with postoperative hepatic dysfunction (group hepatic dysfunction, model for end-stage liver disease score ≥ 15) and 121 patients without postoperative hepatic dysfunction (group non-hepatic dysfunction, model for end-stage liver disease score < 15). Univariate and multiple analyses (logistic regression) were used to identify the predictive risk factors. RESULTS: In-hospital mortality rate was 8.3%. Multiple logistic analysis showed that preoperative alanine aminotransferase (P < .001), cardiopulmonary bypass time (P < .001), and red blood cell transfusion (P < .001) were independent determinants for postoperative hepatic dysfunction. The patients were followed up for 2 years, with an average follow-up of 22.9 ± 3.2 months, and the lost follow-up rate was 9.1%. The short- and medium-term mortality in hepatic dysfunction group was higher than that in non-hepatic dysfunction group (log-rank P = .009). CONCLUSIONS: The incidence of postoperative hepatic dysfunction is high in patients with acute type A aortic dissection. Preoperative alanine aminotransferase, cardiopulmonary bypass time, and red blood cell transfusion were independent risk factors for those patients. The short- and medium-term mortality in hepatic dysfunction group was higher than that in non-hepatic dysfunction group.