Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection

Background: This study was aimed to investigate the incidence, risk factors, and outcomes of patients with postoperative hepatic dysfunction (PHD) after frozen elephant trunk (FET) for type A aortic dissection (TAAD).Method: A retrospective study was performed with 492 patients who underwent FET for...

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Autores principales:	Shenghua Liang, Yanxiang Liu, Bowen Zhang, Yaojun Dun, Hongwei Guo, Xiangyang Qian, Xiaogang Sun
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	aortic dissection frozen elephant trunk hepatic dysfunction malperfusion risk factors Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/1262976c03084fff8ba4738adbaf6bba
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spelling	oai:doaj.org-article:1262976c03084fff8ba4738adbaf6bba2021-11-22T06:17:46ZPostoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection2297-055X10.3389/fcvm.2021.739606https://doaj.org/article/1262976c03084fff8ba4738adbaf6bba2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.739606/fullhttps://doaj.org/toc/2297-055XBackground: This study was aimed to investigate the incidence, risk factors, and outcomes of patients with postoperative hepatic dysfunction (PHD) after frozen elephant trunk (FET) for type A aortic dissection (TAAD).Method: A retrospective study was performed with 492 patients who underwent FET for TAAD between 2015 and 2019. Independent risk factors for PHD were determined by multivariate mixed-effect logistic analysis with surgeon-specific factor as a random effect.Results: The incidence of PHD was 25.4% (n = 125) in our cohort. Patients with PHD presented higher early mortality (10.4 vs. 1.1%, p < 0.001), rates of acute kidney injury (42.4 vs. 12.8%, p < 0.001), and newly required dialysis (23.2 vs. 3.0%, p < 0.001) compared with those without PHD. Moreover, with the median follow-up period of 41.3 months, the survival curve was worse in patients with PHD compared with no PHD group (log-rank p < 0.001), whereas it was similar after excluding patients who died within 30 days (log-rank p = 0.761). Multivariable analyses suggested that PHD was predicted by preoperative aspartate transferase [odds ratio (OR), 1.057; 95% confidence intervals (CI), 1.036–1.079; p < 0.001], celiac trunk malperfusion (OR, 3.121; 95% CI, 1.008–9.662; p = 0.048), and cardiopulmonary bypass time (OR, 1.014; 95% CI, 1.005–1.023; p = 0.003). Retrograde perfusion (OR, 0.474; 95% CI, 0.268–0.837; p = 0.010) was associated with a reduced risk of PHD. Celiac trunk malperfusion was an independent predictor for PHD but not associated with early mortality and midterm survival.Conclusions: PHD was associated with increased early mortality and morbidity, but not with late death in midterm survival. PHD was predicted by preoperative aspartate transferase, celiac trunk malperfusion, and cardiopulmonary bypass (CPB) time, and retrograde perfusion was associated with a reduced risk of PHD.Shenghua LiangYanxiang LiuBowen ZhangYaojun DunHongwei GuoXiangyang QianXiaogang SunFrontiers Media S.A.articleaortic dissectionfrozen elephant trunkhepatic dysfunctionmalperfusionrisk factorsDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	aortic dissection frozen elephant trunk hepatic dysfunction malperfusion risk factors Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	aortic dissection frozen elephant trunk hepatic dysfunction malperfusion risk factors Diseases of the circulatory (Cardiovascular) system RC666-701 Shenghua Liang Yanxiang Liu Bowen Zhang Yaojun Dun Hongwei Guo Xiangyang Qian Xiaogang Sun Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection
description	Background: This study was aimed to investigate the incidence, risk factors, and outcomes of patients with postoperative hepatic dysfunction (PHD) after frozen elephant trunk (FET) for type A aortic dissection (TAAD).Method: A retrospective study was performed with 492 patients who underwent FET for TAAD between 2015 and 2019. Independent risk factors for PHD were determined by multivariate mixed-effect logistic analysis with surgeon-specific factor as a random effect.Results: The incidence of PHD was 25.4% (n = 125) in our cohort. Patients with PHD presented higher early mortality (10.4 vs. 1.1%, p < 0.001), rates of acute kidney injury (42.4 vs. 12.8%, p < 0.001), and newly required dialysis (23.2 vs. 3.0%, p < 0.001) compared with those without PHD. Moreover, with the median follow-up period of 41.3 months, the survival curve was worse in patients with PHD compared with no PHD group (log-rank p < 0.001), whereas it was similar after excluding patients who died within 30 days (log-rank p = 0.761). Multivariable analyses suggested that PHD was predicted by preoperative aspartate transferase [odds ratio (OR), 1.057; 95% confidence intervals (CI), 1.036–1.079; p < 0.001], celiac trunk malperfusion (OR, 3.121; 95% CI, 1.008–9.662; p = 0.048), and cardiopulmonary bypass time (OR, 1.014; 95% CI, 1.005–1.023; p = 0.003). Retrograde perfusion (OR, 0.474; 95% CI, 0.268–0.837; p = 0.010) was associated with a reduced risk of PHD. Celiac trunk malperfusion was an independent predictor for PHD but not associated with early mortality and midterm survival.Conclusions: PHD was associated with increased early mortality and morbidity, but not with late death in midterm survival. PHD was predicted by preoperative aspartate transferase, celiac trunk malperfusion, and cardiopulmonary bypass (CPB) time, and retrograde perfusion was associated with a reduced risk of PHD.
format	article
author	Shenghua Liang Yanxiang Liu Bowen Zhang Yaojun Dun Hongwei Guo Xiangyang Qian Xiaogang Sun
author_facet	Shenghua Liang Yanxiang Liu Bowen Zhang Yaojun Dun Hongwei Guo Xiangyang Qian Xiaogang Sun
author_sort	Shenghua Liang
title	Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection
title_short	Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection
title_full	Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection
title_fullStr	Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection
title_full_unstemmed	Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection
title_sort	postoperative hepatic dysfunction after frozen elephant trunk for type a aortic dissection
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/1262976c03084fff8ba4738adbaf6bba
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Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection

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