摘要Background Type A aortic dissection,as a cardiovascular emergency,is best treated with early surgical inter-vention.With advancements in surgical techniques and perioperative management,the clinical cure rate of surgery has significantly improved.However,the probability of postoperative complications remains high,among which postoperative hepatic dysfunction is one of the common and serious complications affecting prognosis.The purpose of this study was to explore the risk factors associated with postoperative hepatic dysfunction in patients with type A aortic dissection,hoping to identify high-risk patients early,prevent postoperative hepatic dysfunction,and improve patient prognosis.Methods A retrospective analysis was conducted on patients diagnosed with Stanford type A aortic dissection and treated with Sun's procedure at Guangdong Provincial People's Hospital from January 1,2021,to October 1,2022.The Model for End-Stage Liver Disease excluding International Normalized Ratio(MELD-Ⅺ)score was used as the evaluation index for postoperative hepatic dysfunction(HD).MELD-Ⅺ scores from postop-erative day 1 to 7 were collected.Statistical methods were employed to analyze the perioperative clinical data of the two groups of patients.Variables with statistical significance in univariate analysis were included in multivariate logistic regression analysis to identify independent risk factors associated with postoperative HD.Results A total of 241 patients diagnosed with Stanford type A aortic dissection and hospitalized for Sun's procedure treatment were selected using specific inclusion and exclusion criteria.All patients were divided into HD group(MELD-Ⅺscore ≥12,n=108)and normal group(MELD-Ⅺ score＜12,n=133),with a postoperative HD incidence rate of 44.81％.There were statistically significant differences(P＜0.05)between the two groups in terms of whether the surgery was emergency,gender distribution,preoperative level of white blood cell count,alanine aminotransferase,aspartate aminotransferase,brain natriuretic peptide,high-sensitivity troponin T,and serum creatinine.Statistically significant differences(P＜0.05)were also observed in surgical duration,cardiopulmonary bypass time,intraopera-tive and postoperative 24-hour red blood cell transfusion volume,intraoperative and postoperative 24-hour plasma transfusion volume,and intraoperative bleeding volume.Moreover,patients with postoperative hepatic dysfunction had longer mechanical ventilation time,longer intensive care unit(ICU)and total hospital stay,and higher probabil-ities of postoperative gastrointestinal bleeding,paraplegia,cerebral complications,re-thoracotomy for hemostasis,reintubation,and extracorporeal membrane oxygenation(ECMO)therapy(P＜0.05).The probabilities of acute kidney injury and receiving hemodialysis treatment were also higher(P＜0.05).Following multivariate regression analysis,preoperative white blood cell count(OR:1.169,95％Cl:1.028-1.329,P=0.017),preoperative serum creat-inine(OR:1.045,95％CI:1.028-1.062,P＜0.001),and intraoperative and postoperative 24-hour red blood cell transfusion volume(OR:1.146,95％CI:1.030-1.274,P=0.012)were identified as independent risk factors associ-ated with postoperative hepatic dysfunction in patients with Stanford type A aortic dissection after Sun's procedure.Conclusions In this study,the incidence of postoperative hepatic dysfunction in patients with Stanford type A aortic dissection after Sun's procedure was relatively high,at 44.81％.The independent risk factors associated with postoperative hepatic dysfunction in patients with type A aortic dissection include preoperative white blood cell count,preoperative alanine aminotransferase,and intraoperative and postoperative 24-hour red blood cell transfu-sion volume.Postoperative hepatic dysfunction significantly affects the prognosis of patients with Stanford type A aortic dissection,increasing the duration of postoperative mechanical ventilation,postoperative hospitalization time,and the probability of postoperative acute kidney injury.