Hyperlactatemia after heart transplantat tied to greater risk of mortality and veno-arterial ECMO initiation: Study
Hyperlactatemia (HL) is a prevalent complication following cardiac surgery. It is related to tissue hypoperfusion and hypoxia. The condition is tied to poor clinical outcomes.
According to a study published in the Journal of Cardiology, Severe hyperlactatemia following orthotopic heart transplant was linked to a higher likelihood of VA ECMO initiation and mortality at 30 days post-transplant.
Although HL is often observed following orthotopic heart transplantation (OHTx), the relationship between the two pertaining to outcomes is unclear. The study investigated the occurrence and consequences of HL in patients following OHTx.
This study examined 209 adult patients who underwent heart transplantation between January 2011 and December 2020. These were stratified into three groups based on peak lactate levels within the first 72 hours postoperatively: group 1 (normal to mild hyperlactatemia, <5 mmol/L, n=42), group 2 (moderate hyperlactatemia, 5-10 mmol/L, n=110), and group 3 (severe hyperlactatemia, >10 mmol/L, n=57). The primary endpoint was all-cause mortality or veno-arterial extracorporeal membrane oxygenation ( VA ECMO) initiation within 30 days, while secondary endpoints included duration of mechanical ventilation, ICU length of stay, and hospital LOS.
Key results of the study are:
- Patients with higher postoperative peak lactate levels were more commonly transplanted from left ventricular assist device support (33.3 % vs 50.9 % vs 64.9). They had longer cardiopulmonary bypass time (127 min vs 141 min vs 153 min)
- 8.6 % of patients (n=18) met the Composite primary endpoint. It was more common in patients with higher postoperative peak lactate levels (0.0 % vs 6.4 % vs 19.3 %).
- Postoperative hyperlactatemia (HL) >5 mmol/L was seen in 79.9% of patients after OHTx.
- Early postoperative HL was tied to a greater risk of mortality and or use of VA ECMO.
- The threshold value was high, around 10 mmol/L. the sensitivity and specificity were 61.1% and 75.9%, respectively.
- There was a 32 % increase in the risk of the primary outcome for each unit increase in lactate with OR 1.32
- CPB time and preoperative durable LVAD were associated with postoperative severe HL.
Concluding further, they found Postoperative HL to be associated with a higher rate of death and or use of VA ECMO. Cardiopulmonary bypass time and preoperative durable left ventricular assist device were related to postoperative severe HL.
Reference:
Doi, A., Batchelor, R., Demase, K. C., Manfield, J. C., Burrell, A., Paul, E., Marasco, S., Kaye, D., & McGiffin, D. C. (2024). Impact of postoperative hyperlactatemia in Orthotopic heart transplantation. Journal of Cardiology. https://doi.org/10.1016/j.jjcc.2024.02.001
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