IMPACT OF DISTAL AORTIC AND VISCERAL PERFUSION ON LIVER-FUNCTION DURING THORACOABDOMINAL AND DESCENDING THORACIC AORTIC REPAIR

Purpose: We examined the impact of distal aortic and visceral perfusio n on liver function during thoracoabdominal and descending thoracic ao rtic repair. Methods: Between January 1991 and July 1996, 367 patients underwent thoracoabdominal and descending thoracic aortic repair. Bas eline and postoperative total bilirubin, alanine aminotransferase, asp artate aminotransferase, alkaline phosphatase, lactate dehydrogenase, fibrinogen, prothrombin time (PT), and partial thromboplastin time (PT T) were measured for 286 patients. We examined the impact of distal ao rtic and direct visceral perfusion on liver function-related clinical laboratory values. Univariate and multivariate statistical methods for categorical and continuous variables were used. Results: In categoric al analysis, type II thoracoabdominal aortic aneurysm, history of hepa titis, and emergency presentation had a statistically significant mult ivariate association with abnormal laboratory values. In continuous-di stributed multivariate data analysis, type II thoracoabdominal aortic aneurysm and visceral perfusion were statistically significant predict ors of postoperative alkaline phosphatase, PT, and PTT. Type II aneury sms increased postoperative liver function-related laboratory values s ignificantly above other aneurysm types (alkaline phosphatase, +114 IU , p < 0.0001; PT, +1.99 sec ends, p < 0.02; PTT, +6.7 seconds, p < 0.0 3). Visceral perfusion was associated with a concomitant decrease (alk aline phosphatase, -101.2 IU, p < 0.0001; PT, -1.8 seconds, p. < 0.07; PTT, -5.6 seconds, p< 0.02). Conclusions: Visceral perfusion negates the rise in postoperative liver function-related clinical laboratory v alues associated with type II thoracoabdominal aortic aneurysm repair.