Can postoperative serum lactate levels predict mortality in infants after open heart surgery?

Abstract

Objective: Complex cardiac surgery is a cause of high morbidity and mortality in newborn infants.Elevated lactate levels after congenital cardiac surgery are indicative of tissue hypoperfusion and are associated with increased morbidity and mortality.Serial lactate measurements are crucial in monitoring prognosis in this patient group. Monitoring lactate levels is important in the management of patients after congenital heart surgery to predict and prevent adverse events. Methods: Between July 2017 and December 1, 2022, the data of 115 patients aged 0-1 year who were followed up and treated at a pediatric cardiovascular surgery center, treated surgically, and underwent cardiopulmonary bypass during surgery were retrospectively evaluated. Results: Cardiopulmonary bypass duration and operative time were longer and postoperative serum lactate levels were higher in the mortality group. Logistic regression analysis revealed a significant association between mortality and serum lactate levels (p<0.01, B=0.34). In multivariate analysis, a lactate level of 5.6 mmol/L in the first postoperative hour and 3.42 mmol/L in the 24th postoperative hour were associated with higher mortality. Conclusion: Increased lactate levels are frequently encountered in the postoperative period and are associated with increased mortality and morbidity.

Keywords

• Lactat
• congenital heart surgery
• cardiopulmonary bypass
• mortality

References

1. Maminirina P, Pavy C, Bourgoin P, et al. Continuous cerebral and myocardial selective perfusion in neonatal aortic arch surgery. J Card Surg. 2020;35(11):2920-2926.
2. Shukla VV, Bobhate P, Mohanty S, et al. Early Outcomes of Neonatal Cardiac Surgery in India. Indian Pediatr. 2020;57(2):129-132.
3. Kansy A, Tobota Z, Maruszewski P, et al. Analysis of 14,843 neonatal congenital heart surgical procedures in the European Association for Cardiothoracic Surgery Congenital Database. Ann Thorac Surg. 2010;89(4):1255-1259.
4. Manikis P, Jankowski S, Zhang H, et al. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med. 1995;13(6):619-622
5. Valencia E, Staffa SJ, Nathan M, et al. Hyperlactataemia as a predictor of adverse outcomes post-cardiac surgery in neonates with congenital heart disease. Cardiol Young. 2021;31(9):1401-1406.
6. Ranucci M, Isgrò G, Romitti F, et al. Anaerobic metabolism during cardiopulmonary bypass: predictive value of carbon dioxide derived parameters. Ann Thorac Surg. 2006;81(6):2189-2195.
7. Raper RF, Cameron G, Walker D, et al. Type B lactic acidosis following cardiopulmonary bypass. Crit Care Med. 1997;25(1):46-51.
8. Desplanque L, Hamaide-Defrocourt F, Berkia I, et al. Lactate clearance in infants undergoing surgery for congenital heart disease. Artif Organs. 2019;43(1):54-59.

9. Şahutoğlu C, Yaşar A, Kocabaş S, et al.. Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg. 2018;26(3):375-385..
10. Seghrouchni A, Atmani N, Moutakiallah Y, et al. Does severe hyperlactatemia during cardiopulmonary bypass predict a worse outcome?. Ann Med Surg (Lond). 2021;73:103198.
11. Schumacher KR, Reichel RA, Vlasic JR, et al. Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2014;148(2):589-595.
12. Murtuza B, Wall D, Reinhardt Z, et al. The importance of blood lactate clearance as a predictor of early mortality following the modified Norwood procedure. Eur J Cardiothorac Surg. 2011;40(5):1207-1214.
13. Jenkins KJ, Gauvreau K, Newburger JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123(1):110-118.
14. Molina Hazan V, Gonen Y, Vardi A, et al. Blood lactate levels differ significantly between surviving and nonsurviving patients within the same risk-adjusted Classification for Congenital Heart Surgery (RACHS-1) group after pediatric cardiac surgery. Pediatr Cardiol. 2010;31(7):952-960.
15. Khaled D. Algarni. The effect of hyperlactatemia timing on the outcomes after cardiac surgery. The Cardiothoracic Surgeon. 2020;28(1):1-8.