Acta Scientific Clinical Case Reports

Research Article Volume 2 Issue 7

Frequency of Morbidity and Mortality with Increased Lactate Level After Open Heart Surgery at Tertiary Care Hospital

Vikram Kumar1, Zubair Ahmed1, Ali Raza Brohi2*, Hafeezullah1, Asmat Achakzai1 and Suhayb Ahmed Khushk1

1National Institute of Cardiovascular Diseases, Karachi, Pakistan
2People’s University of Medical and Health Sciences, Nawabshah, Pakistan

*Corresponding Author: Ali Raza Brohi, Professor and Chairman, Department of Paediatric Surgery, People’s University of Medical and Health Sciences, Nawabshah, Pakistan.

Received: May 04, 2021; Published: June 29, 2021

Abstract

Introduction: Hyperlactatemia is frequently encountered during and after cardiac surgery and has many causes that include tissue hypoxia as well as nonhypoxic causes such as drug therapy, cardioplegia, hypothermia and cardiopulmonary bypass (CPB). Morbidity and mortality are related directly to the preoperative status of the patient, as well as to specific anesthetic, surgical and postoperative factors in the cardiac surgery. The maintenance of appropriate hemodynamic goals is essential to improve outcomes after cardiac surgery.

Objective: The objective of the study was to determine the frequency of mortality and morbidity among patients with increased lactate levels after open heart surgery at tertiary care hospital.

Materials and Methods: A Case series study was conducted in Surgical ICU, Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi. The duration of study was 6 months after the approval of the synopsis. This study includes 143 hyperlactatemic patients who underwent open heart surgery at National Institute of Cardiovascular Diseases, Karachi. All the patients who fulfilled the inclusion criteria were included in the study. Detailed medical history of patients was collected after obtaining informed consent from patients including demographic characteristics (gender and age), history of myocardial infarction, hypertension, congestive heart failure and diabetes. All patients ABG sample was collected at 6, 12 and 18 hours to measure the lactate levels. All collected information was recorded in proforma for evaluation of results.

Results: In present study, 143 patients were selected out of which 83 (58.0%) patients were male and 60 (42.0%) were female with mean age of 61.24 ± 11.720 years. Patients underwent for open heart surgery developed hyperlactatemia during CPB that causes; increased surgery time (3.5 ± 0.93 hours), increased serum lactate at 6 hours (3.69 ± 1.97), at 12 hours (3.39 ± 1.81) and at 18 hours (3.12 ± 1.35) mmol/L, increased ICU stay (51.31 ± 11.78 hours) and hospital stay (12.79 ± 4.31 days). Hyperlactatemia also increases the morbidity and mortality rate (13.3%) in open heart surgery patients.

Conclusion: It was concluded from the study that patients underwent open heart surgery are at a higher risk of development of hyperlactatemia (≥ 4.0 mmol/L) that increases the post-operative morbidity and mortality.

Introduction: Hyperlactatemia is frequently encountered during and after cardiac surgery and has many causes that include tissue hypoxia as well as nonhypoxic causes such as drug therapy, cardioplegia, hypothermia and cardiopulmonary bypass (CPB). Morbidity and mortality are related directly to the preoperative status of the patient, as well as to specific anesthetic, surgical and postoperative factors in the cardiac surgery. The maintenance of appropriate hemodynamic goals is essential to improve outcomes after cardiac surgery.

Objective: The objective of the study was to determine the frequency of mortality and morbidity among patients with increased lactate levels after open heart surgery at tertiary care hospital.

Materials and Methods: A Case series study was conducted in Surgical ICU, Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi. The duration of study was 6 months after the approval of the synopsis. This study includes 143 hyperlactatemic patients who underwent open heart surgery at National Institute of Cardiovascular Diseases, Karachi. All the patients who fulfilled the inclusion criteria were included in the study. Detailed medical history of patients was collected after obtaining informed consent from patients including demographic characteristics (gender and age), history of myocardial infarction, hypertension, congestive heart failure and diabetes. All patients ABG sample was collected at 6, 12 and 18 hours to measure the lactate levels. All collected information was recorded in proforma for evaluation of results.

Results: In present study, 143 patients were selected out of which 83 (58.0%) patients were male and 60 (42.0%) were female with mean age of 61.24 ± 11.720 years. Patients underwent for open heart surgery developed hyperlactatemia during CPB that causes; increased surgery time (3.5 ± 0.93 hours), increased serum lactate at 6 hours (3.69 ± 1.97), at 12 hours (3.39 ± 1.81) and at 18 hours (3.12 ± 1.35) mmol/L, increased ICU stay (51.31 ± 11.78 hours) and hospital stay (12.79 ± 4.31 days). Hyperlactatemia also increases the morbidity and mortality rate (13.3%) in open heart surgery patients.

Conclusion: It was concluded from the study that patients underwent open heart surgery are at a higher risk of development of hyperlactatemia (≥ 4.0 mmol/L) that increases the post-operative morbidity and mortality.

Keywords: Hyperlactatemia; Cardiac Surgery; Drug Therapy; Cardiopulmonary Bypass

References

  1. Maillet JM., et al. “Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery”. Journal of Chest 5 (2003): 1361-1366.
  2. D O'Connor E and Fraser JF. “Hyperlactatemia in critical illness and cardiac surgery”. Critical Care 3 (2010): 421.
  3. Jabbari A., et al. “Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method”. Caspian Journal of Internal Medicine 2 (2013): 662-666.
  4. Ayhan B., et al. “The effects of non-leukoreduced red blood cell transfusions on microcirculation in mixed surgical patients”. Transfusion and Apheresis Science 2 (2013): 212-222.
  5. Levy B. “Lactate and shock state: the metabolic view”. Current Opinion in Critical Care 4 (2006): 315-321.
  6. Hajjar LA., et al. “Lactate and base deficit are predictors of mortality in critically ill patients with cancer”. Critical Care 2 (2011): P18.
  7. Leavy JA., et al. “Lactate washout' following circulatory arrest”. The Journal of the American Medical Association 5 (1988): 662-664.
  8. Mak NT., et al. “Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: a matched cohort study”. Journal of Cardiothoracic Surgery 1 (2016): 33.
  9. Naik R., et al. “Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: Causative factors and its effect on surgical outcome”. Annals of Cardiac Anaesthesia 4 (2016): 668-675.
  10. Hajjar LA., et al. “High lactate levels are predictors of major complications after cardiac surgery”. The Journal of Thoracic and Cardiovascular Surgery2 (2013): 455-460.
  11. Demers P., et al. “Outcome with high blood lactate levels during cardiopulmonary bypass in adult cardiac operation”. The Annals of Thoracic Surgery6 (2000): 2082-2086.
  12. Munoz R., et al. “Changes in whole blood lactate levels during CPB for surgery for congenital cardiac disease: an early indicator of morbidity and mortality”. The Journal of Thoracic and Cardiovascular Surgery1 (2000): 155-162.
  13. Joudi M., et al. “Factors affecting on serum lactate after cardiac surgery”. Anesthesia and Pain Medicine4 (2014): e18514.
  14. Muhammad Sadeghi M., et al. “Relationship between serum lactate levels and morbidity outcomes in cardiovascular patients after CABG”. Journal of Surgery Pakistan International2 (2008): 88-91.
  15. Hajjar LA., et al. “High lactate levels are predictors of major complications after cardiac surgery”. The Journal of Thoracic and Cardiovascular Surgery2 (2013): 455-460.
  16. Mak NT., et al. “Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: a matched cohort study”. Journal of Cardiothoracic Surgery1 (2016): 33.
  17. Oğuz S., et al. “The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors”. Erciyes Medical Journal1 (2014): 24-28.

Citation

Citation: Ali Raza Brohi., et al. “Frequency of Morbidity and Mortality with Increased Lactate Level After Open Heart Surgery at Tertiary Care Hospital". Acta Scientific Clinical Case Reports 2.7 (2021): 92-99.

Copyright

Copyright: © 2021 Ali Raza Brohi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.278

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