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

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.

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Postoperative liver dysfunction after total arch replacement combined with frozen elephant trunk implantation: incidence, risk factors and outcomes

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz209 ◽

2019 ◽

Vol 29 (6) ◽

pp. 930-936 ◽

Cited By ~ 1

Author(s):

Lijing Yang ◽

Jun Li ◽

Guyan Wang ◽

Hui Zhou ◽

Zhongrong Fang ◽

...

Keyword(s):

Risk Factors ◽

Cardiopulmonary Bypass ◽

Liver Dysfunction ◽

Multivariable Analysis ◽

Total Arch Replacement ◽

Frozen Elephant Trunk ◽

Erythrocyte Transfusion ◽

Elephant Trunk ◽

Postoperative Liver Dysfunction ◽

Independent Risk Factors

Abstract OBJECTIVES The authors aimed to clarify the incidence and risk factors of postoperative liver dysfunction (PLD) in patients undergoing total arch replacement combined with frozen elephant trunk implantation and to determine the association of PLD with short-term outcomes. METHODS Data from 672 adult patients undergoing total arch replacement with frozen elephant trunk from January 2013 until December 2016 at Fuwai Hospital were analysed retrospectively. A multivariable logistic regression model was used to identify the risk factors for PLD. RESULTS The overall incidence of PLD was 27.5%, which was associated with higher in-hospital mortality (PLD 4.9% vs No PLD 0.8%, P = 0.002) and 30-day mortality (PLD 9.2% vs No PLD 2.5%, P < 0.001) and a higher incidence of major adverse events (PLD 54.6% vs No PLD 23.4%, P < 0.001). In the multivariable analysis, preoperative hypotension [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.14–3.41; P = 0.02), coronary artery disease (OR 2.64, 95% CI 1.17–5.96; P = 0.02), prolonged cardiopulmonary bypass duration (OR 1.01, 95% CI 1.00–1.01; P < 0.001), increased preoperative alanine transferase (OR 1.01, 95% CI 1.00–1.01; P < 0.001), preoperative platelet count <100 × 109/l (OR 3.99, 95% CI 1.74–9.14; P = 0.001) and increased intraoperative erythrocyte transfusion (OR 1.07, 95% CI 1.01–1.12; P = 0.02) were identified as independent risk factors for PLD. CONCLUSIONS PLD was associated with increased mortality and morbidity. Among the independent risk factors for PLD, cardiopulmonary bypass duration and erythrocyte transfusion could be modifiable. A skilled surgical team and an ideal blood protection strategy may be helpful to protect liver function.

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Risk Factors for Permanent Neurological Dysfunction and Early Mortality in Patients with Type A Aortic Dissection Requiring Total Arch Replacement

The Heart Surgery Forum ◽

10.1532/hsf.1983 ◽

2018 ◽

Vol 21 (3) ◽

pp. 221 ◽

Cited By ~ 1

Author(s):

Li Jiang ◽

Sai Chen ◽

Zhao Jian ◽

Yingbin Xiao

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Multivariate Logistic Regression Analysis ◽

Type A ◽

Early Mortality ◽

Total Arch Replacement ◽

Neurological Dysfunction ◽

Definitive Treatment ◽

Elephant Trunk ◽

Type A Aortic Dissection

Background: Surgery is a definitive treatment for patients with type A aortic dissection. The aim of this study was to identify and analyze the risk factors for permanent neurological dysfunction (PND) and 30-day mortality in patients following total arch replacement and stented elephant trunk implantation in the descending aorta. Methods: The clinical data of 85 consecutive patients who underwent this surgical procedure between December 2013 and May 2017 were reviewed. Multivariate logistic regression analysis was performed to determine the independent predictors of postoperative PND and 30-day mortality. Results: There were 62 males and 23 females, with a mean age of 47.6 ± 11.7 years (range, 26-73 years). Ten patients (11.76%) developed PND after surgery. Postoperative 30-day mortality was 11.76% (10/85), including one death during hospitalization and nine deaths after discharge. Multivariate analysis showed that hypertension was independently associated with postoperative PND (OR = 4.407, 95% CI: 1.021-19.023, P = .047), and age and postoperative PND were independent predictors for 30-day mortality (OR, 1.120; 95% CI, 1.026-1.221; P = .011 and OR, 7.503; CI, 1.290-43.634; P = .025, respectively). Conclusion: Hypertension was independently associated with postoperative PND, and age and postoperative PND were predictors for early mortality in patients who underwent total arch replacement and stented elephant trunk implantation.

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Total Aortic Arch Replacement Using the Frozen Elephant Trunk Technique: Early Mortality is Mainly Influenced by the Underlying Pathology

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1571635 ◽

2016 ◽

Vol 64 (S 01) ◽

Author(s):

C. Detter ◽

J. Brickwedel ◽

M. Coutandin ◽

A. Bernhardt ◽

H. Reichenspurner

Keyword(s):

Aortic Arch ◽

Early Mortality ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Total Aortic Arch Replacement ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique ◽

Underlying Pathology

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Extended repair for acute type A aortic dissection: long-term outcomes of the frozen elephant trunk technique beyond 10 years

The Journal of Cardiovascular Surgery ◽

10.23736/s0021-9509.20.11293-x ◽

2020 ◽

Vol 61 (3) ◽

Cited By ~ 3

Author(s):

Wei-Guo Ma ◽

Yu Chen ◽

Wei Zhang ◽

Qing Li ◽

Jian-Rong Li ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Long Term Outcomes ◽

Elephant Trunk ◽

Type A Aortic Dissection ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

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Frozen elephant trunk infection: to defrost or to debranch?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa466 ◽

2020 ◽

Author(s):

Joseph Nader ◽

Yuthiline Chabry ◽

Houda Nazih ◽

Thierry Caus

Keyword(s):

Proximal Part ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Hybrid Prosthesis

Abstract Infections of frozen elephant trunk hybrid prosthesis (HP) are not well documented in the literature and their management is not standardized yet. We report herein the case of a 59-year-old patient who benefited from a Thoraflex™ HP aortic arch replacement for an acute type A aortic dissection. He presented a year later with a Staphylococcus aureus infection of the proximal part of this prosthesis. We performed a replacement of the proximal compound of the HP accompanied by a complete debranching of the 3 supra-aortic vessels with an inter-carotidal retro-oesophageal bypass. As we left in situ the endovascular graft within the descending aorta, a life-long antibiotic therapy was introduced. The postoperative follow-up was uneventful, and the patient discharged home 2 weeks after his surgery. As an alternative to a more radical redo surgery with major risk, a hybrid medical and surgical treatment of infected frozen elephant trunk could be considered.

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