Heliyon (Oct 2023)
Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study
- Fausto Biancari,
- Francesco Nappi,
- Giuseppe Gatti,
- Andrea Perrotti,
- Amélie Hervé,
- Stefano Rosato,
- Paola D'Errigo,
- Matteo Pettinari,
- Sven Peterss,
- Joscha Buech,
- Tatu Juvonen,
- Mikko Jormalainen,
- Caius Mustonen,
- Till Demal,
- Lenard Conradi,
- Marek Pol,
- Petr Kacer,
- Angelo M. Dell’Aquila,
- Konrad Wisniewski,
- Igor Vendramin,
- Daniela Piani,
- Luisa Ferrante,
- Timo Mäkikallio,
- Eduard Quintana,
- Robert Pruna-Guillen,
- Antonio Fiore,
- Thierry Folliguet,
- Giovanni Mariscalco,
- Metesh Acharya,
- Mark Field,
- Manoj Kuduvalli,
- Francesco Onorati,
- Cecilia Rossetti,
- Sebastien Gerelli,
- Dario Di Perna,
- Enzo Mazzaro,
- Angel G. Pinto,
- Javier Rodriguez Lega,
- Mauro Rinaldi
Affiliations
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland; Corresponding author. Heart and Lung Center, Helsinki University Hospital, 00029 Helsinki, Finland.
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
- Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
- Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
- Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
- Stefano Rosato
- Center for Global Health, National Health Institute, Rome, Italy
- Paola D'Errigo
- Center for Global Health, National Health Institute, Rome, Italy
- Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
- Sven Peterss
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
- Joscha Buech
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
- Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
- Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Caius Mustonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Till Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
- Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
- Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Angelo M. Dell’Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
- Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
- Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
- Daniela Piani
- Cardiothoracic Department, University Hospital, Udine, Italy
- Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
- Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
- Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Spain
- Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Spain
- Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
- Thierry Folliguet
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
- Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
- Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
- Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
- Cecilia Rossetti
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
- Sebastien Gerelli
- Centre Hospitalier Annecy Genevois, France
- Dario Di Perna
- Centre Hospitalier Annecy Genevois, France
- Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
- Angel G. Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
- Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
- Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
- Journal volume & issue
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Vol. 9,
no. 10
p. e20702
Abstract
Background: Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD. Methods: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery. Results: Data on arterial lactate concentration immediately before surgery were available in 2798 (71.7 %) patients. Preoperative concentration of arterial lactate was an independent predictor of in-hospital mortality (mean, 3.5 ± 3.2 vs 2.1 ± 1.8 mmol/L, adjusted OR 1.181, 95%CI 1.129–1.235). The best cutoff value preoperative arterial lactate concentration was 1.8 mmol/L (in-hospital mortality, 12.0 %, vs. 26.6 %, p < 0.0001). The rates of in-hospital mortality increased along increasing quintiles of arterial lactate and it was 12.1 % in the lowest quintile and 33.6 % in the highest quintile (p < 0.0001). The difference between multivariable models with and without preoperative arterial lactate was statistically significant (p = 0.0002). The NRI was 0.296 (95%CI 0.200–0.391) (p < 0.0001) with −17 % of events correctly reclassified (p = 0.0002) and 46 % of non-events correctly reclassified (p < 0.0001). The IDI was 0.025 (95%CI 0.016–0.034) (p < 0.0001). Six studies from a systematic review plus the present one provided data for a pooled analysis which showed that the mean difference of preoperative arterial lactate between 30-day/in-hospital deaths and survivors was 1.85 mmol/L (95%CI 1.22–2.47, p < 0.0001, I2 64 %). Conclusions: Hyperlactatemia significantly increased the risk of mortality after surgery for acute TAAD and should be considered in the clinical assessment of these critically ill patients.
