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Does severe hyperlactatemia during cardiopulmonary bypass predict a worse outcome?
Aniss Seghrouchni1,2, Noureddine Atmani1,2, Younes Moutakiallah1
1Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco.
Insights
Elevated blood lactate levels after cardiopulmonary bypass (CPB) in open heart surgery patients are linked to increased mortality and complications. Monitoring and managing lactate levels are crucial for better patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Cardiopulmonary bypass (CPB) is a critical component of open heart surgery.
- Increased blood lactate levels during CPB can indicate compromised tissue perfusion.
- Understanding the impact of hyperlactatemia on surgical outcomes is essential.
Purpose of the Study:
- To evaluate the association between elevated blood lactate levels post-CPB and immediate outcomes in open heart surgery patients.
- To identify specific complications linked to different levels of hyperlactatemia.
Main Methods:
- Retrospective single-center study of 1290 adult cardiac surgical patients.
- Exclusion of patients with pre-existing liver dysfunction or hemodynamic instability.
- Classification into three groups based on post-CPB arterial lactate levels: normal (<2 mmol/l), mild (2-5 mmol/l), and severe (>5 mmol/l).
Main Results:
- Severe hyperlactatemia (>5 mmol/l) was significantly correlated with adverse outcomes.
- Associated complications included higher in-hospital mortality, low output cardiac syndrome, renal insufficiency, and myocardial infarction.
- Patients with severe hyperlactatemia required more red blood cell transfusions, prolonged mechanical ventilation, and longer ICU stays.
Conclusions:
- Blood lactate levels exceeding 5 mmol/l after CPB are associated with increased in-hospital mortality and postoperative complications.
- Effective management of CPB-related abnormalities is necessary to ensure adequate tissue perfusion.
- Reducing hyperlactatemia risk is key to improving patient recovery after open heart surgery.
Introduction:
The aim of the current study was to evaluate the impact of increased blood lactate levels during cardiopulmonary bypass (CPB) on immediate results in patients who underwent open heart surgery.
Materials And Methods:
We performed a retrospective single-center study on 1290 patients. Adult cardiac surgical patients who underwent valve surgery, coronary artery bypass graft, combined procedure, adult congenital anomalies and aortic surgery were enrolled. Patients with associated comorbidities such as liver dysfunction, hemodynamic instability before surgery were excluded. Arterial blood lactate concentration was measured immediately after weaning from CPB and evaluated together with clinical data and outcomes including in hospital mortality. Patients were classified into 3 groups according to their peak arterial lactate level: group I [normal lactatemia, lactate ˂ 2 mmol/l (n = 749)], group II [mild hyperlactatemia, lactate 2-5 mmol/l (n = 489)], group III [severe hyperlactatemia, lactate ˃ 5 mmol/l (n = 52)].
Results:
When comparing outcomes across the 3 groups, severe hyperlactatemia was correlated with worse outcomes including higher in-hospital mortality, low output cardiac syndrome, postoperative renal insufficiency, myocardial infarction, red blood cell transfusion (RBC) transfusion, prolonged mechanical ventilation and longer intensive care unit (ICU) stay hours.
Conclusion:
Blood lactate level above 5 mmol/l and more during CPB is associated with higher in-hospital mortality rate and postoperative complications. More attention must be given to correct the common abnormalities conditions inherent of CPB in order to conduct adequate tissue perfusion and reduce the risk of hyperlactatemia.
