Wang Zhigang, Ge Min, Chen Cheng, Lu Lichong, Zhang Lifang, Wang Dongjin
Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.
Department of Psychiatry, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.
J Cardiothorac Surg. 2021 Oct 10;16(1):296. doi: 10.1186/s13019-021-01676-8.
Hepatic dysfunction (HD) increases the morbidity and mortality rates after cardiac surgery. However, few studies have investigated the association between HD and acute DeBakey type I aortic dissection (ADIAD) surgery. This retrospective study aimed to identify risk factors for developing HD in patients who received acute type I aortic dissection repair and its consequences.
A total of 830 consecutive patients who received ADIAD surgery from January 2014 to December 2019 at our center were screened for this study. The End-Stage Liver Disease (MELD) score more than 14 was applied to identify postoperative HD. Logistic regression model was applied to identify risk factors for postoperative HD, Kaplan-Meier survival analysis and Cox proportional hazards regression assay were conducted to analyze the association between HD and postoperative long-term survival.
Among 634 patients who eventually enrolled in this study, 401 (63.2%) experienced postoperative HD with a 30-Day mortality of 15.5%. Preoperative plasma fibrinogen level (PFL) [odds ratio (OR): 0.581, 95% confidence interval (CI): 0.362-0.933, P = 0.025], serum creatinine (sCr) on admission (OR: 1.050, 95% CI 1.022-1.079, P < 0.001), cardiopulmonary bypass (CPB) time (OR: 1.017, 95% CI 1.010-1.033, P = 0.039), and postoperative mechanical ventilation (MV) duration (OR: 1.019, 95% CI 1.003-1.035, P = 0.020) were identified as independent risk factors for developing postoperative HD by multivariate analyses. In addition, the Kaplan-Meier analysis indicated that the long-term survival rate was significantly different between patients with or without postoperative HD. However, the hazard ratios of long-term survival for these two groups were not significantly different.
HD was a common complication after ADIAD surgery and associated with an increasing 30-Day mortality rate. Decreased PFL, elevated sCr, prolonged CPB duration, and longer postoperative MV time were independent risk factors for postoperative HD.
肝功能障碍（HD）会增加心脏手术后的发病率和死亡率。然而，很少有研究调查HD与急性Ⅰ型主动脉夹层（ADIAD）手术之间的关联。这项回顾性研究旨在确定接受急性Ⅰ型主动脉夹层修复术患者发生HD的危险因素及其后果。
对2014年1月至2019年12月在本中心连续接受ADIAD手术的830例患者进行筛查。采用终末期肝病（MELD）评分大于14来确定术后HD。应用逻辑回归模型确定术后HD的危险因素，进行Kaplan-Meier生存分析和Cox比例风险回归分析以分析HD与术后长期生存之间的关联。
在最终纳入本研究的634例患者中，401例（63.2%）发生术后HD，30天死亡率为15.5%。多因素分析确定术前血浆纤维蛋白原水平（PFL）[比值比（OR）：0.581，95%置信区间（CI）：0.362-0.933，P = 0.025]、入院时血清肌酐（sCr）（OR：1.050，95%CI 1.022-1.079，P < 0.001）、体外循环（CPB）时间（OR：1.017，95%CI 1.010-1.033，P = 0.039）和术后机械通气（MV）持续时间（OR：1.019，95%CI 1.003-1.035，P = 0.020）为术后发生HD的独立危险因素。此外，Kaplan-Meier分析表明，术后有或无HD的患者长期生存率有显著差异。然而，这两组患者长期生存的风险比无显著差异。
HD是ADIAD手术后的常见并发症，与30天死亡率增加相关。PFL降低、sCr升高、CPB持续时间延长和术后MV时间延长是术后HD的独立危险因素。
