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The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection.

ABSTRACT:

Background

Hepatic dysfunction (HD) is a common complication that can occur after surgical repair of acute type A aortic dissection (ATAAD) and is associated with poor prognosis. However, the incidence of early preoperative HD and the associated risk factors in patients with ATAAD have not been fully elucidated.

Methods

A total of 984 ATAAD patients who received surgical repair within 48 hours of symptom onset at our department from January 2014 to December 2019 were retrospectively analyzed. Patients were divided into the non-HD group and the HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery. The clinical parameters and clinical outcomes of the 2 groups were collected and compared.

Results

Preoperative HD was detected in 268 patients (27.2%). The incidence of in-hospital complications, including the need for dialysis (34.0% vs. 9.2%; P<0.001), was significantly higher in patients with HD compared to patients without HD (69.8% vs. 51.0%; P<0.001). Patients with HD had a higher 30-day mortality rate compared to patients without HD (20.1% vs. 8.4%; P<0.001). Multivariate analysis demonstrated that preoperative cardiac tamponade, preoperative serum creatinine levels, and serum troponin T levels upon admission were independent predictors for preoperative HD in patients with ATAAD. Interestingly, even though preoperative HD was associated with an increased 30-day mortality rate, it did not significantly affect the long-term mortality rate (log-rank P=0.259).

Conclusions

Early HD before surgery was commonly observed in patients with ATAAD and was associated with increased in-hospital complications after surgery, but did not significantly affect long-term survival.

SUBMITTER: Wang Z

PROVIDER: S-EPMC8575816 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection.

Wang Zhigang Z Chen Tao T Ge Min M Chen Cheng C Lu Lichong L Zhang Lifang L Wang Dongjin D

Journal of thoracic disease 20211001 10

<h4>Background</h4>Hepatic dysfunction (HD) is a common complication that can occur after surgical repair of acute type A aortic dissection (ATAAD) and is associated with poor prognosis. However, the incidence of early preoperative HD and the associated risk factors in patients with ATAAD have not been fully elucidated.<h4>Methods</h4>A total of 984 ATAAD patients who received surgical repair within 48 hours of symptom onset at our department from January 2014 to December 2019 were retrospective ...[more]

PMID: 34795914

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Project description:ObjectivesThe association between preoperative D-dimer with morphologic features and surgical outcomes of acute type A aortic dissection is still unclear.Methods430 acute type A aortic dissection patients who underwent total arch replacement and frozen elephant trunk in Beijing Anzhen Hospital of Capital Medical University between January 2016 and December 2020 were enrolled in the present study. Patients were divided into higher D-dimer (>2307 ng/ml) group and lower D-dimer (≤2307 ng/ml) group. We compared the extent of dissection and branch artery perfusion patterns between the 2 groups. The restricted cubic spline was performed to assess the association between D-dimer with the extent of dissection and major adverse events after surgery.ResultsAmong 430 patients, there were 45 (10.47%) in-hospital mortality and 156 (36.28%) major adverse events. Patients with higher D-dimer had bigger dissection extension length and false lumen perimeter in ascending aorta, thoracic descending aorta, diaphragmatic, coeliac trunk and renal artery level. For the branch artery perfusion patterns, patients with higher D-dimer had a higher proportion of malperfusion among the innominate artery, right renal artery and both side iliac arteries, a higher proportion of dissected intercostal artery/all intercostal arteries >0.5 (43.46% vs 29.63%, P = 0.003). The restricted cubic spline linear regression model revealed a nonlinear association between lnD-dimer with extension length and false lumen perimeter (all P for overall and P for nonlinearity <0.001 except false lumen perimeter in ascending aorta level). The restricted cubic spline logistic regression model revealed a linear association between lnD-dimer with major adverse events (P for overall <0.001, P for nonlinearity = 0.637). The association between lnD-dimer and major adverse events was still significant in the fully adjusted logistic regression model with computed tomography angiography characteristics [odds ratio (95% confidence interval) =1.388 (1.137, 1.695), P = 0.001].ConclusionsPreoperative D-dimer strongly and positively correlates with the extent of dissection and major adverse events of acute type A aortic dissection after total arch replacement and frozen elephant trunk. D-dimer seems to be a supplement that indicates the severity of aortic dissection to aortic computed tomography angiography.

Project description:BackgroundAcute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgical intervention. This retrospective study aimed to clarify the individual characteristics, short-term and mid-term outcomes, and prognostic factors of patients who underwent surgical repair of ATAAD with preoperative cardiopulmonary resuscitation (CPR).MethodsBetween January 2007 and January 2020, 656 consecutive patients underwent ATAAD repair at our institution; 22 (3.4%) of these patients underwent CPR prior to surgery. Patients who underwent preoperative CPR were classified as the survivor group (n = 9) and non-survivor group (n = 13), according to whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed and compared. Three-year cumulative survival rates and cerebral performance categories (CPC) scores are presented.ResultsIn patients undergoing CPR prior to ATAAD surgery, the in-hospital mortality rate was 59.1%. A total of 72.7% of patients underwent concomitant surgical resuscitation procedures during CPR such as emergent subxiphoid pericardiotomy and/or emergent cardiopulmonary bypass. The survivor group had a higher rate of return of spontaneous heartbeat (ROSB) compared to the non-survivor group (100% versus 53.8%; P = 0.017). The 3-year cumulative survival rates were 35.1% (95% confidence interval [CI], 27.6%-42.6%) and 85.7% (95% CI, 81.9%-88.8%) for overall patients and for survivors, respectively. As for the neurological outcome, 77.8% (7/9) of patients had full cerebral performance (CPC-1) at the 3-month follow-up examination after discharge.ConclusionsPatients with ATAAD undergoing preoperative CPR, especially those without ROSB after CPR, are at high risk for in-hospital mortality. However, the short-term and mid-term outcomes, including the cerebral performance after discharge and 3-year survival rate, are promising for patients who survived to discharge.

Dataset Information

The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection.

Background

Methods

Results

Conclusions

Publications

The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection.

Similar Datasets

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