Correlation Between Serum Lactate Levels and Outcome in Pediatric Patients Undergoing Congenital Heart Surgery

Correlación entre los Niveles Séricos de Lactato y el Resultado en Pacientes Pediátricos Sometidos a Cirugía Cardíaca Congénita

This article aims to investigate the correlation between lactate levels in the first 24 hours, as well as the possible complications and the incidence of morbidity and mortality in pediatric congenital heart disease patients who underwent open heart surgery.

This retrospective study included a total of 236 patients who underwent open heart surgery due to congenital heart disease (121 males, 115 females; mean age 56.4 months (median: 42 month): range, 1 day to 204 months) between June 2014 and May 2016, in a Turkish hospital.

The primary endpoint was the correlation between elevated lactate levels, complications, and mortality. The secondary endpoint was to determine risk factors for the first 30-day mortality.

In terms of mortality, lactate levels of ≥4.5 mmol/L at any time, prolonged mechanical ventilation, and undergoing complex surgery (high RACHS-1 scores) were found to be independent risk factors for mortality. Lactate levels ranged from 0.1 to 15.9 mmol/L in survivors and from 0.7 to 19.9 mmol/L in nonsurvivors.

This study found that high levels of arterial lactate (≥4.5 mmol/L), complex surgery (high RACHS-1 scores, category 4-6) and prolonged mechanical ventilation duration (>48 hours) were associated with increased mortality in pediatric patients undergoing congenital heart surgery.

In conclusion, lactate levels in congenital heart surgery play a critical role in the morbidity and mortality of patients. High Risk-adjusted Classification for Congenital Heart Surgery-1 category, high inotropic scores, being in the cyanotic patient group, prolonged cardiopulmonary bypass duration and aortic cross-clamp time, and prolonged duration of operation and anesthesia may increase lactate levels.

This study was completed by Cengiz Şahutoğlu, Ahmet Yaşar, Seden Kocabaş, Fatma Zekiye Aşkar, Mehmet Fatih Ayık and Yüksel Atay, and it was published in 2018 by Turkish Journal of Thoracic and Cardiovascular Surgery 2018;26(3):375-385

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