The relative risk factors analysis of hepatic dysfunction following aortic dissection repair / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To analyze the risk factors of hepatic dysfunction following Stanford A and stanford B aortic dissection repair with deep hypothermic circulatory arrest (DHCA).</p><p><b>METHODS</b>Between January 2006 and June 2008, 208 patients [156 male and 52 female, mean aged (45 ± 11) years] underwent open repairs of aortic dissection with DHCA. Indications for surgical intervention were type A aortic dissection in 181 patients and type B in 27 patients. Acute aortic dissection occurred on 121 patients, chronic aortic dissection occurred on 87 patients. Complications included hypertension, diabetes, cardiac dysfunction, renal dysfunction, and hepatic dysfunction. Twenty-one patients had previous aortic surgery. Data were gathered for multiple preoperative and intraoperative factors including age, gender, diagnosis, aortic dissection type, preoperative ejection fraction, aortic surgery history, surgical intervention type, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, blood transfusion volume (PRBC). Serum glutamic-pyruvic transaminase (GPT), 1-lactate dehydrogenase (LDH) and total bilirubin (TBIL) were assayed before and after operation, as well as 12 h, 1 d, 3 d, 5 d, 7 d. These valuables were recorded and described statistically. All the factors were evaluated by means of univariate and multivariate Logistic analysis to identify relative risk factors of hepatic dysfunction.</p><p><b>RESULTS</b>The CPB time and aortic cross-clamp time were (189 ± 48) min and (93 ± 41) min, respectively. Hepatic dysfunction occurred in 18 (8.7%) patients. Serum GPT and serum LDH elevated significantly within 24 h after aortic surgery, and then went down gradually. Postoperative serum TBIL were much higher than preoperative level on the first day and there was no significant reduction during the following seven days. Preoperative serum creatinine > 133 µmol/L (P < 0.01), preoperative GPT > 40 U/L (P < 0.01), acute aortic dissection (P < 0.05), CPB time > 180 min (P < 0.05), aortic cross-clamp time > 100 min (P = 0.035), PRBC > 10 unit (P < 0.01) were the risk factors for hepatic dysfunction. Furthermore preoperative GPT > 40 U/L (P < 0.01) and PRBC > 10 unit (P < 0.01) were independent determinants for hepatic dysfunction.</p><p><b>CONCLUSIONS</b>Multiple risk factors impact the onset of postoperative hepatic dysfunction. Rather, a combination of factors, especially preoperative hepatic injury, massive blood transfusion produced the highest odds of deficit.</p>