The relative risk factors analysis of death for hepatic dysfunction following aortic dissection repair

Objective There is a paucity of data regarding hepatic dysfunction (HD) following type A and B aortic dissection repair with deep hypothermic circulatory arrest (DHCA). We determine the incidence and outcomes for postoperative HD, and analyze the risk factors of death for HD. Methods Between January 2006 and June 2008, 208 patients have undergone 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. 18 patients had postoperative hepatic dysfunction with abnormal hepatic enzyme and bilirubin.The mean patient age was 43 years and one third were women. Perioperative data including age, sex, type, surgery intervention, CPB time, aortic-clamp time and ICU retention time were collected. Complications were classified as bleeding, low cardiac output, acute renal failure, hypoxemia, infection, temporary neurologic dysfunction, multiple organ dysfunction and death.Serum GPT, LDH and TBIL were assayed and recorded before and after operation, as well as 12 h, 1 d, 3 d, 5 d, 7 d. Risk factors for death of hepatic dysfunction were ascertained by univariate and multivariable analysis. Results The incidence of hepatic dysfunction within one week following surgery is 8.7%. The mortality associated with HD was 39% compared with 1.6% (P＜0.0001) in patients without HD. ICU retention time were significantly different (P＜0.001) between HD grorp (11.9days) and non-HD group (4.2days). In this group, intraoperative and postoperative 24 hours blood transfusion volume (PRBC) ＞20 U occurred in 6 patients, reopen for bleeding in 3 patients, low cardiac output in 6 patients, sepsis in 1 patients, acute renal failure in 7 patients, hypoxemia in 5 patients, severe infection in 2 patients, temporary neurologic dysfunction in 5 patients, multiple organ dysfunction in 10 patients. Bleeding( P = 0. 024 ), low cardiac output (P = 0. 024 ), acute renal failure ( P = 0. 024), MOD ( P = 0.002) are the risk factors of death for hepatic dysfunction. And independent determinants were bleeding (P= 0.019) and MOD ( P = 0.001 ). Conclusion Multiple risk factors impact the onset of postoperative hepatic dysfunction. Bleeding and MOD after aortic dissection surgical repairs were associated with an increased mortality. Key words: Aorta; Aneurysm, dissecting; Postoperative complications; Liver failure; Hemorrhage