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Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery
Cengiz Şahutoğlu1, Ahmet Yaşar1, Seden Kocabaş1
1Department of Anesthesiology and Reanimation, Medicine Faculty of Ege University, İzmir, Turkey.
Insights
Elevated perioperative arterial lactate levels (≥4.5 mmol/L) in children undergoing congenital heart surgery are linked to increased morbidity and mortality. Monitoring lactate is crucial for predicting outcomes in pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiac Surgery
- Intensive Care Medicine
- Biochemistry
Background:
- Congenital heart disease necessitates complex surgical interventions in pediatric patients.
- Assessing perioperative risk factors is critical for improving outcomes in pediatric cardiac surgery.
Purpose of the Study:
- To investigate the correlation between perioperative arterial lactate levels and postoperative morbidity and mortality in children undergoing cardiac surgery.
- To identify arterial lactate level thresholds indicative of adverse outcomes.
Main Methods:
- Retrospective analysis of 236 pediatric patients undergoing open heart surgery for congenital heart disease.
- Recording of arterial blood gas analysis, including lactate levels, at multiple perioperative time points.
- Patients categorized into two groups based on lactate levels: <4.5 mmol/L and ≥4.5 mmol/L.
Main Results:
- A lactate level of ≥4.5 mmol/L was observed in 22.5% of patients.
- Patients with lactate levels ≥4.5 mmol/L exhibited significantly higher rates of complications (p=0.027) and mortality (p<0.001).
- Independent risk factors for mortality included lactate levels ≥4.5 mmol/L, prolonged mechanical ventilation, and complex surgery.
Conclusions:
- Perioperative arterial lactate level of ≥4.5 mmol/L is a significant risk factor for postoperative morbidity and mortality in pediatric cardiac surgery.
- Lactate monitoring can aid in risk stratification and management of these high-risk patients.
Background:
This study aimed to investigate the correlation between perioperative arterial lactate levels and morbidity and mortality in children undergoing cardiac surgery.
Methods:
A total of 236 patients who underwent open heart surgery due to congenital heart disease (121 males, 115 females; mean age 56.4 month (median: 42 month): range, 1 day to 204 month) between June 2014 and May 2016 were retrospectively analyzed. The arterial blood gas analysis results at baseline (after insertion of arterial cannula), during the cooling and warming-up phases in cardiopulmonary bypass, during the sternal closure, and at 0, 6, 12, and 24 hours in the postoperative intensive care unit stay were recorded. The patients were divided into two groups according to their lactate levels: Group 1 (lactate level <4.5 mmol/L, n=183) and Group 2 (lactate level ≥4.5 mmol/L, n=53). Correlation between the lactate groups and demographic data, intraoperative and postoperative variables, postoperative complications, and mortality were investigated.
Results:
Sixty-nine patients (29.2%) had cyanotic heart disease. A total of 53 patients (22.5%) had lactate levels of ≥4.5 mmol/L. At least one complication occurred in 41% of the patients. Development of at least one complication (p=0.027) and mortality rate (p<0.001) were significantly higher in the patients with lactate levels of ≥4.5 mmol/L. Seventeen patients (7.2%) died in the postoperative period, and 15 of them had lactate levels of ≥4.5 mmol/L at least once within the first 24 hours. In terms of mortality, lactate levels of ≥4.5 mmol/L at any time, prolonged mechanical ventilation (>48 hours), and undergoing complex surgery (high the Risk-adjusted Classification for Congenital Heart Surgery-1 score, category 4-6) were the independent risk factors for mortality.
Conclusion:
Blood arterial lactate level of ≥4.5 mmol/L was found to be a risk factor for postoperative morbidity and mortality in pediatric patients undergoing congenital heart surgery.
