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Ann Thorac Surg 2000;70:2082-2086
© 2000 The Society of Thoracic Surgeons

Original article: cardiovascular

Outcome with high blood lactate levels during cardiopulmonary bypass in adult cardiac operation

Philippe Demers, MDa, Stéphane Elkouri, MDa, Raymond Martineau, MDa, André Couturier, MSca, Raymond Cartier, MDa

a Division of Cardiothoracic Surgery, Departments of Surgery, and Departments of Anesthesia and Biostatistics, Montreal Heart Institute, Montreal, Quebec, Canada

Accepted for publication May 15, 2000.

Address reprint requests to Dr Cartier, Montreal Heart Institute 5000 Bélanger St E, Montreal, Qc, H1T 1C8, Canada
e-mail: cartierr{at}icm.umontreal.ca

Background. High blood lactate levels during cardiopulmonary bypass (CPB) are associated with tissue hypoperfusion and may contribute to postoperative complications or death. The objective of this study was to determine an association between blood lactate levels during CPB and perioperative morbidity and mortality.

Methods. We reviewed 1,376 patients who underwent cardiac operation with CPB. Patients with abnormal preoperative blood lactate levels were excluded (n = 101). Blood lactate concentration during CPB, clinical data, and perioperative events were recorded.

Results. Peak blood lactate levels of 4.0 mmol/L or higher during CPB were present in 227 patients (18.0%). Postoperative mortality was higher in this group than in the patients who had peak blood lactate levels of less than 4.0 mmol/L during CPB (11.0% versus 1.4%; p < 0.001, relative risk [RR] = 9.0). Postoperative hemodynamic instability occurred in 29.5% of patients with elevated levels of lactate during CPB compared with 10.9% of patients with lower lactate levels (p < 0.001, RR = 3.4). Overall, major postoperative complications occurred in 43.2% and 21.8% of patients in each group, respectively (p < 0.001, RR = 2.7). Logistic regression analysis revealed that peak blood lactate levels of 4.0 mmol/L or higher during CPB were strongly associated with postoperative mortality (p = 0.0001) and morbidity (p = 0.013).

Conclusions. Blood lactate concentration of 4.0 mmol/L or higher during CPB identifies a subgroup of patients with increased risk of postoperative morbidity and mortality.




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