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

Abstract

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.

Hepatic dysfunction and adverse outcomes after total arch repair of acute type a aortic dissection: application of the MELD-XI score

“…Kumle et al found that when the CPB time > 180 min, abnormal metabolic function of liver and the destruction of hepatocyte microstructure can occur. [19] Our results show that when the CPB time > 180 min, the risk of severe adverse outcomes in PHD patients increases significantly. Cardiopulmonary bypass is an abnormal physiological circulation in which non-pulsatile blood flow leads to reduced liver perfusion during operation.…”

Hybrid Treatment of Complex Diseases of the Aortic Arch and Descending Thoracic Aorta by Frozen Elephant Trunk Technique

“…Several studies emphasized that lower-body MHCA duration negatively impacts visceral risk despite the theoretical protective effect of hypothermia [76,77]. In order to reduce lower-body MHCA time and improve distal organ protection, several authors advocated for prompt lower-body reperfusion after completion of the distal anastomosis, using a side branch or a balloon cannula as an endoclamp within the FET [78][79][80]. The Ancona team and other authors have proposed off-pump retrograde vascular stent-graft deployment in distal arch/DTA and the use of a retrograde endoballoon for prompt lower-body reperfusion, allowing TAR during uninterrupted normothermic cerebral and lower-body perfusion [81].…”

Hepatic dysfunction and adverse outcomes after total arch repair of acute type A aortic dissection: Application of the MELD-XI score

“…Previous research found that patients with celiac trunk malperfusion before frozen elephant trunk for type A aortic dissection had a trend toward higher early postoperative morality rate. 21…”