Risk stratification using serum lactate in patients undergoing surgical pulmonary embolectomy

Area of Science:

• Cardiovascular Surgery
• Pulmonary Embolism Management
• Critical Care Medicine

Background:

• Surgical pulmonary embolectomy (SPE) is an established cardiac surgery procedure.
• Indications for SPE have narrowed due to advances in thrombolytic and interventional therapies.
• Risk stratification is crucial for optimizing outcomes in patients undergoing SPE.

Purpose of the Study:

• To analyze serum lactate levels for risk stratification in patients with massive and submassive pulmonary embolism (PE).
• To evaluate the correlation between serum lactate levels and in-hospital mortality and morbidity after SPE.

Main Methods:

• Retrospective analysis of 82 patients who underwent SPE between January 1997 and January 2020.
• Patients stratified into two groups based on initial venous serum lactate levels: normolactatemia (<2 mmol/L) and hyperlactatemia (>2 mmol/L).
• Primary endpoint: all-cause in-hospital mortality. Secondary endpoints: cardiopulmonary bypass time, ECMO use, low cardiac output, blood product usage, and RV function.

Main Results:

• Overall in-hospital mortality was 8.54%.
• Hyperlactatemia group showed significantly higher mortality (P=.015) and morbidity, including longer cardiopulmonary bypass time (P=.008), increased ECMO insertion (P=.036), and open chest procedures (P=.015).
• While 5-year survival favored the normolactatemia group, long-term survival showed no statistical difference between groups.

Conclusions:

• Long-term survival following SPE is generally favorable.
• Risk stratification using biomarkers like serum lactate can potentially improve outcomes.
• Serum lactate should be considered alongside imaging modalities in PE management algorithms.