Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Postoperative adrenalineinduced hyperlactatemia in patients undergoing surgical correction of heart valves defects

Authors: Yudin G.V., Goncharov A.A., Rybka M.M., Lomakin M.V., Dibin D.A.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2021-18-2-149-157

UDC: 616.12-007.1-083.98:615.217.24

Link: Clinical Physiology of Blood Circulaiton. 2021; 2 (18): 149-157

Quote as: Yudin G.V., Goncharov A.A., Rybka M.M., Lomakin M.V., Dibin D.A. Postoperative adrenaline-induced hyperlactatemia in patients undergoing surgical correction of heart valves defects. Clinical Physiology of Circulation. 2021; 18 (2): 149–57 (in Russ.). DOI: 10.24022/1814-6910-2021-18-2-149-157

Received / Accepted:  09.04.2021 / 01.05.2021

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Abstract

Objective. To determine the predictor significance of serum lactate concentration as a marker of adrenaline-induced hyperlactatemia in patients undergoing surgical correction of heart valves defects.

Material and methods. A retrospective cohort study involving 1020 patients initially operated on heart valves, divided into two groups depending on the profile of inotropic support: the dobutamine group (n = 495) and the adrenaline group (n = 525). The study excluded patients whose intra- and early postoperative period was complicated by the development of acute heart failure, organ dysfunction, and blood loss of more than 1000 ml. A comparative analysis of the serum lactate concentration after the end of the operation and its maximum concentration in the first postoperative day was performed, and their predictor significance as a marker of adrenaline-induced hyperlactatemia was revealed on the basis of regression analysis.

Results. In the adrenaline group higher serum lactate concentrations were observed after the operation, 5.1 ± 3.4 mmol/l versus 1.7 ± 1.4 mmol/l in the dobutamine group (p < 0.0001), and its maximum concentration in the first postoperative day, 8.7 ± 5.0 mmol/l versus 3.0±2.7 mmol/l in the dobutamine group (p < 0.0001). As a marker of adrenaline-induced hyperlactatemia, the concentration of serum lactate after surgery was 2.6 mmol/l with a sensitivity of 82% and a specificity of 80% (AUC 0.87; CI 0.85–0.9) and the maximum level of lactatemia in the first postoperative day of 7.1 mmol/l with a sensitivity of 61%, specificity of 90% (AUC 0.8; CI 0.78–0.83).

Conclusion. In the case of uncomplicated course of intraoperative and early postoperative periods during inotropic adrenaline support in patients operated on heart valves, hyperlactatemia with a serum lactate concentration after the operation of 2.6 mmol/l and its maximum concentration on the first postoperative day of 7.1 mmol/l has an adrenaline-induced character.

About Authors

  • Gennadiy V. Yudin, Cand. Med. Sc., Anesthesiologist-Intensivist; ORCID
  • Andrey A. Goncharov, Anesthesiologist-Intensivist; ORCID
  • Mikhail M. Rybka, Dr. Med. Sc., Head of Department of Anesthesiology; ORCID
  • Maksim V. Lomakin, Anesthesiologist-Intensivist; ORCID
  • Denis A. Dibin, Anesthesiologist-Intensivist;ORCID

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