Impact of postoperative hyperlactatemia in orthotopic heart transplantation.
J Cardiol
; 84(4): 239-245, 2024 Oct.
Article
em En
| MEDLINE
| ID: mdl-38354768
ABSTRACT
BACKGROUND:
Hyperlactatemia (HL) is a common phenomenon after cardiac surgery which is related to tissue hypoperfusion and hypoxia and associated with poor outcomes. It is also often seen in the postoperative period after orthotopic heart transplantation (OHTx), but the association between HL and outcomes after OHTx is not well known. We evaluated the incidence and outcome of HL after OHTx.METHODS:
This was a retrospective study of 209 patients who underwent OHTx between January 2011 and December 2020. Patients were classified into 3 groups according to their peak lactate levels within the first 72â¯h postoperatively group 1, normal to mild hyperlactatemia (<5â¯mmol/L, nâ¯=â¯42); group 2, moderate hyperlactatemia (5-10â¯mmol/L, nâ¯=â¯110); and group 3, severe hyperlactatemia (>10â¯mmol/L, nâ¯=â¯57). The primary composite endpoint was all-cause mortality or postoperative initiation of veno-arterial extracorporeal membrane oxygenation (VA ECMO) within 30â¯days. Secondary endpoints included duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay.RESULTS:
Patients with higher postoperative peak lactate levels were more commonly transplanted from left ventricular assist device support (33.3â¯% vs 50.9â¯% vs 64.9, pâ¯<â¯0.01) and had longer cardiopulmonary bypass time [127â¯min (109-148) vs 141â¯min (116-186) vs 153â¯min (127-182), pâ¯=â¯0.02]. Composite primary endpoint was met in 18 patients (8.6â¯%) and was significantly more common in patients with higher postoperative peak lactate levels (0.0â¯% vs 6.4â¯% vs 19.3â¯%, pâ¯<â¯0.01).CONCLUSIONS:
Severe hyperlactatemia following orthotopic heart transplant was associated with an increased risk of post-transplant VA ECMO initiation and mortality at 30â¯days.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Transplante de Coração
/
Hiperlactatemia
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article