Extreme Hyperlactatemia After Heart Transplantation: One Center's Experience

Hsu, Yung-Chi; Hsu, Che-Hao; Huang, Go-Shine; Lu, Chih Cherng; Wu, Zhi-Fu; Tsai, Yi‐Ting; Lin, Chih-Yuan; Lin, Yu‐Liang; Tsai, Chien‐Sung; Lin, Tzu-Chen

doi:10.1016/j.transproceed.2015.02.027

Cited by 13 publications

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“…In the presented research, hyperlactatemia was considered with the of >1.6 mmol/l, same as it is for other cardiac surgeries and non-surgical patients in our center. Despite the initially emerging pattern with early peak of the lactate values, that was similar to other post-HTX lactate analyses (Hsu et al, 2015;Hoshino, Kinoshita & Ono, 2018), more detailed evaluation revealed various serum lactate level trends. The interpretation of the initial results indicates the increase to the highest serum lactate level within first 6 postoperative hours with subsequent gradual decrease (Fig.…”

Section: Discussionsupporting

confidence: 75%

“…The extreme hyperlactatemia was defined by Hsu et al as the serum lactate level greater than 15 mmol/L and occurred in 3 patients at the ICU admission and in 9 others within early postoperative hours (12/58 patients). In spite of the further serum lactate level decrease below four mmol/L, one-third of the analyzed hyperlactatemia subgroup deceased within the hospitalization, and the others within nearly 5 years post-HTX (Hsu et al, 2015). In another study, the cut-off level of four mmol/L was set according to the guidelines for severe sepsis and septic shock treatment.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative hyperlactatemia and serum lactate level trends among heart transplant recipients

Kędziora

Wierzbicki

Piątek

et al. 2020

PeerJ

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Background Advanced heart failure (HF), that affects 10% of the HF population, is associated with high mortality rate, meeting 50% at 1-year from diagnosis. For these individuals, heart transplantation (HTX) remains the ultimate and the gold-standard treatment option. Serum lactate level measurements has been proven useful for determining the outcome following other cardiac surgeries and among critically ill patients. Increased serum lactate levels are expected following HTX; however, no detailed analysis has been yet performed in this population. The research aims to estimate the prevalence of hyperlactatemia and describe early postoperative serum lactate level trends among heart transplant recipients. Materials and Methods Forty-six consecutive patients, who underwent HTX between 2010 and 2015, were enrolled into the retrospective analysis. Serum lactate level measurements within first 48 hours post-HTX were obtained every 6 hours from routinely conducted arterial blood gas analyses. The threshold for hyperlactatemia was considered at >1.6 mmol/L, according to upper limit of normal, based on internal laboratory standardization. The highest observed measurement within the observation, regardless of the time point of observation was determined for each patient individually and was appointed as Peak Value. Results Consecutively measured serum lactate levels differed in time (p = 0.000), with the initial increase and subsequent decrease of the values (4.3 vs. 1.9 mmol/l; p = 0.000). The increase from the baseline level to the Peak Value was statistically significant (4.3 vs. 7.0 mmol/l; p = 0.000). Various serum lactate level trends were identified, with one or more hyperlactatemia episodes. Eventually, 50% of the individuals had normal serum lactate levels at the end of the study, and hyperlactatemia was observed in the other half. Conclusions Throughout the observation, all of the patients experienced at least one episode of hyperlactatemia, with the median Peak Value of 7.0 (4.5–8.4) mmol/L. Various serum lactate level trends can be identified in post-HTX patients. Further research is required to determine the clinical usefulness of newly reported serum lactate level trends among heart transplant recipients.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Postoperative hyperlactatemia and serum lactate level trends among heart transplant recipients

Kędziora

Wierzbicki

Piątek

et al. 2020

PeerJ

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“…6,12) Hsu, et al 13) reported that HL occurred in 12 of 58 patients (21%). As the cutoff level of HL was 15 mmol/L in that study, the incidence in their population might have been higher given the difference in the cutoff level.…”

Section: Discussionmentioning

confidence: 99%

The Incidence, Risk Factors, and Outcomes of Hyperlactatemia after Heart Transplantation

2018

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SummaryHyperlactatemia (HL) is associated with tissue hypoperfusion during cardiac surgery, which results in postoperative morbidity and mortality among patients undergoing cardiopulmonary bypass surgery. The aim of this study was to determine the incidence, risk factors, and outcome of HL after heart transplantation (HTx) in one of the largest Japanese single-center cohorts. We retrospectively studied the lactate levels in 49 patients who underwent HTx at the University of Tokyo Hospital from August 1, 2010 to November 30, 2015. All of the patients were over 20 years of age. Arterial blood samples were analyzed during the operation and until 24 hours after surgery. Twenty-nine patients (59.2%) had HL after intensive-care unit admission. At 24 hours after surgery, the lactate levels of all patients had recovered to the normal range. A multivariate analysis showed that the total ischemic time of the donor heart (odds ratio [OR], 1.0176; 95% confidence interval [CI], 1.0004-1.0375; P = 0.0444) and the duration of preoperative left ventricular assist device (LVAD) support (OR, 0.9977; 95% CI, 0.9952-0.9997; P = 0.0218) were risk factors for HL. Pulmonary complications were noted in 24.1% of the patients with high lactate values but in none of the patients without HL (P = 0.0182); however, there were no cases of hospital death, and the length of hospital stay did not differ to a statistically significant degree between HL groups (P = 0.719). Although HL after HTx was common, it appeared to be transient and benign. Donor heart ischemia and the duration of preoperative LVAD support were associated with HL after transplantation.(Int Heart J 2018; 59: 81-86)

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“…Lactic acidosis is commonly observed after heart transplantation. It is known to be related to low cardiac output, poor peripheral perfusion, and excessive catecholamine www.kjtcvs.org KJTCVS administration [11,12]. The relatively low postoperative peak lactate level in the CPS+ group demonstrates that supplemental cardioplegia infusion may have a positive effect on allograft protection.…”

Section: Kjtcvs Discussionmentioning

confidence: 99%

The Effect of Supplemental Cardioplegia Infusion before Anastomosis in Patients Undergoing Heart Transplantation with Long Ischemic Times

Kim

Jung

Yang

et al. 2020

Korean J Thorac Cardiovasc Surg

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This paper was presented at the 50th Fall Conference of the Korean Society for Thoracic and Cardiovascular Surgery. Background: Prolonged ischemic time is a risk factor for primary graft dysfunction in patients who undergo heart transplantation. We investigated the effect of a supplemental cardioplegia infusion before anastomosis in patients with long ischemic times. Methods: We identified 236 consecutive patients who underwent orthotopic heart transplantation between February 2010 and December 2014. Among them, the patients with total ischemic times of longer than 3 hours (n=59) were categorized based on whether they were administered a complementary cardioplegia solution (CPS) immediately before implantation (CPS+, n=30; CPS−, n=29). Results: The mean total ischemic times in the CPS+ and CPS− groups were 238.1±30.1 minutes and 230.1±28.2 minutes, respectively (p=0.3). The incidence of left ventricular primary graft dysfunction (CPS+, n=6 [20.0%]; CPS−, n=5 [17.2%]; p=0.79) was comparable between the groups. In the Kaplan-Meier survival analysis, no significant difference in overall survival at 5 years was observed between the CPS+ and CPS− groups (83.1%±6.9% vs. 89.7%±5.7%, respectively; log-rank p=0.7). No inter-group differences in early mortality (CPS+, n=0; CPS−, n=1 [3.4%]; p=0.98) or complications were observed. Conclusion: The additional infusion of a cardioplegia solution immediately before implantation in patients with longer ischemic times is a simple, reproducible, and safe procedure. However, we did not observe benefits of this strategy in the present study.

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Extreme Hyperlactatemia After Heart Transplantation: One Center's Experience

Cited by 13 publications

References 14 publications

Postoperative hyperlactatemia and serum lactate level trends among heart transplant recipients

Postoperative hyperlactatemia and serum lactate level trends among heart transplant recipients

The Incidence, Risk Factors, and Outcomes of Hyperlactatemia after Heart Transplantation

The Effect of Supplemental Cardioplegia Infusion before Anastomosis in Patients Undergoing Heart Transplantation with Long Ischemic Times

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