Hyperlactatemia as a Risk Stratification for Postinfarction Ventricular Septal Rupture

Area of Science:

• Cardiology
• Surgical Critical Care
• Biomarkers

Background:

• Postinfarction ventricular septal rupture (VSR) repair is a high-risk surgical procedure, particularly in hemodynamically unstable patients.
• Lactate serves as a quantitative indicator of end-organ ischemia, reflecting cardiac output and overall patient status.

Purpose of the Study:

• To evaluate the utility of preoperative serum lactate levels for risk stratification in patients undergoing surgical repair of VSR.
• To determine the association between preoperative lactate levels and mortality following VSR repair.

Main Methods:

• Retrospective analysis of 33 consecutive patients who underwent VSR repair within 24 hours of admission.
• Patients were stratified into three groups based on preoperative blood lactate levels: <5 mmol/L, 5-10 mmol/L, and >10 mmol/L.

Main Results:

• No intraoperative deaths occurred, but prognosis was poor for patients with lactate >10 mmol/L (median survival 23 days; 83% mortality within 30 days).
• A 1-unit increase in log-transformed preoperative lactate was associated with a 2.85-fold increased risk of mortality.
• Patients with lactate 5-10 mmol/L and >10 mmol/L had 3.95-fold and 6.03-fold higher mortality risks, respectively, compared to those with lactate <5 mmol/L.

Conclusions:

• Elevated preoperative serum lactate is significantly associated with increased mortality in patients undergoing VSR repair.
• Measuring preoperative lactate levels is valuable for risk stratification in this patient population.