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

Hyperlactatemia after coronary bypass grafting, performed with cardiopulmonary bypass

Authors: D.Sh. Samuilova, G.V. Lobacheva, I.V. Samorodskaya, U.L. Borovkova, I.I. Skopin, L.A. Boсkeria

A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences

E-mail: Сведения доступны для зарегистрированных пользователей.

Link: Clinical Physiology of Blood Circulaiton. 2014; (): -

Quote as: Samuilova D.Sh., Lobacheva G.V., Samorodskaya I.V., at al. Hyperlactatemia after coronary bypass grafting, performed with cardiopulmonary bypass. Klinicheskaya Fiziologiya Krovoobrashcheniya. 2014; 1: 44–52.

Full text:  


Objective. The aim of the study was to define frequency and reasons of hyperlactatemia occurs in patients underwent coronary bypass grafting (CABG).

Material and methods. The retrospective study included 329 adult patients who underwent CABG between January and December 2011. Results. Hyperlactatemia was observed in 45.8% patients during or immediately after the surgery. In the postoperative period, we observed variable changes in lactate levels (lactate levels remained unchanged, increased or decreased). Low hematocrit (<24%), cardiopulmonary bypass longer than 120 min, hyperglycemia (>11 mmol/l) or their combination were frequently associated with patients who developed hyperlactatemia. Patients with hyperlactatemia were more likely to be exposed to a combination of pre- and intraoperative risk factors for metabolic disorders.

Conclusion. The obtained results suggest that hyperlactatemia in the studied patients is mostly caused by a combination of pre- and intraoperative risk factors. Stimulation of aerobic glycolysis also plays a role in lactate formation. Aerobic glycolysis results from hyperglycemia, which develops not only in response to the release of endogenous stress hormones, but also in response to adrenaline injection.


1. Kapoor P.M., Mandal B., Chowdhurg U.K., Singl S., Kiran U. et al. Changes in myocardial lactate, piruvate and lactate-piruvate ratio during cardiopulmonary bypass for elective adult cardiac surgery: Early indicator of morbility. J. Clin. Anaesthesiol. Pharmacol. 2011; 27 (2): 225–32. 2. Maillet J.M., Le Besnerais P., Cantoni M., Nataf P., Ruffenach A., Lessana A., Brodaty D. Frequency risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest. 2003; 123 (5): 1361–6. 3. Jansen T.C., van Bommel J., Woodward R., Mulder P.G., Bakker J. Association between blood lactate levels. Sequential organ failure assesment subcores, and 28-day mortality during early and late intensive care unit stay: a retrospective observational study. Crit. Care Med. 2009; 37 (8): 2369–74. 4. O’Conner E., Fraser J.F. The interpretation of perioperative lactate abnormalities in patients undergoing cardiac surgery. Anaesth.Intensive Care. 2012; 40 (4): 598–603. 5. Ranucci M., De Toffol B., Isgró G., Romitti F., Conti D., Vincentini M. et al.Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome. Crit. Care. 2006; 10 (6): R167. 6. Heringlake M., Wernerus M., Grünefeld J. The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting. Crit. Care. 2007; 11 (2): R51. 7. Campbell C.H. The severe lactic acidosis of thiamine deficience: Acute perniciosus or fulminating beriberi. Lancet. 1984; 3: 446–9. 8. Levraut J., Ciebiera J.P., Chave S., Rabary O., Jambou P., Carles M., Grimaud D. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rathe than overproduction. Am. J. Resp. Crit. Care Med. 1998; 157 (4Pt1): 1021–6. 9. Valenza F., Aletti G., Fossali T., Chevallard G., Sacconi F., Irace M., Cattinoni L. Lactate as a marker of energy failure in critically ill patients: hypothesis. Crit. Care. 2005; 9 (8): 588–93. 10. Khosravani H., Shahpori R., Stelfox H.T. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit. Care. 2009; 13 (3): R90. 11. Maasoumi G., Sabery K. Comparison of blood electrolytes and glucose during cardiopulmonary bypass in diabetic and non-diabetic patients. J. Res. Med. Sci. 2013; 18 (4): 322–6. 12. Barth E., Abbuszies G., Baumgart K., Matejovic M., Wachter U., Vogt J. et al. Glucose metabolism and catecholamines. Crit. Care Med. 2007; 35 (9): S508–18. 13. Huybregts R.A., de Vroege R., Jansen E.K., van Schijndel A.W., Christiaans H.M., van Oeveren W. The association of hemodilution and transfusion of red blood cells with biochemical markers of splanchnic and renal injury during cardiopulmonary bypass. Anesth. Analg. 2009; 109 (2): 331–9. 14. Senay S., Toraman F., Karabulut H., Alhan C. Is it the patient or the physican who cannot tolerate anemia? Perfusion. 2009; 24 (6): 373–80. 15. Habib R.H., Zacharias A., Schwann T.A., Riordan C.J., Durham S.J., Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult should current practice be changed? J. Cardiovasc. Thorac. Surg. 2003; 125 (6): 1438–50. 16. Бокерия Л.А., Самородская И.В., Самуилова Д.Ш., Боровкова У.Л. Гематологические и биохимические предикторы течения послеоперационного периода у кардиохирургических больных (ретроспективное исследование). Клиническая физиология кровообращения. 2012; 4: 25–30. 17. Mehta R.H., Castelvecchio S., Ballotta A., Frigiola A., Bossone E., Ranussi M. Assotiation of gender and lowest hematocrit on cardiovascular bypass with acute kidney injury and operative mortality in patients undergoing cardiac surgery. Ann. Thorac. Surg. 2013; 96 (1): 133–40.

 If you found mistakes, select text and press Alt+A