Preoperative Hyperlactatemia Predicts Mortality in Acute Stanford Type A Dissection: A 16-Year-Period, Single-Center,...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Intensive Care Medicine

Background:

• Acute Stanford Type A aortic dissection (ATAAD) is a critical surgical emergency.
• Organ malperfusion is a life-threatening complication of ATAAD.
• Lactate levels serve as an indicator of anaerobic glycolysis and organ malperfusion.

Purpose of the Study:

• To evaluate preoperative lactate levels as a surrogate marker for patient outcomes after ATAAD surgery.
• To determine the predictive value of lactate acidosis for mortality in ATAAD patients.
• To analyze the impact of preoperative lactate on short-term and long-term survival.

Main Methods:

• Retrospective analysis of 306 consecutive ATAAD patients from 2000-2016.
• Serum lactate measurements obtained preoperatively.
• Maximal selected rank statistics used to determine lactate cut-point (3.71 mmol/L).

Main Results:

• Patients with lactate > 3.71 mmol/L had significantly higher 30-day mortality (51.5% vs. 18.7%).
• Elevated lactate (> 3.71 mmol/L) was the strongest predictor of 30-day mortality (OR = 7.292).
• This association persisted for overall mortality (HR = 2.772), but age was the only significant factor for long-term survival post-30 days.

Conclusions:

• Preoperative lactate is an accessible surrogate marker for organ malperfusion in ATAAD.
• A preoperative lactate level > 3.71 mmol/L is the strongest predictor of early mortality following ATAAD surgery.
• Lactate levels effectively identify high-risk patients for early adverse outcomes.