Risk stratification using serum lactate in patients undergoing surgical pulmonary embolectomy

Abstract

Background Surgical pulmonary embolectomy (SPE) has been around since the early days of cardiac surgery. But with the increase in thrombolytic and intervention options, indications of SPE have been limited. Literature suggests that risk stratification has been a key step in getting good results. We are analyzing serum lactate levels for risk stratification in massive and submassive pulmonary embolism (PE). Methods This study is a retrospective analysis of 82 cases that underwent SPE between January 1997 and January 2020. Patients were divided into two groups stratified by venous serum lactate levels on the first admission (Group I: normolactatemia <2 mmol/L, Group II: hyperlactatemia, >2 mmol/L). Primary endpoints were all‐cause in‐hospital mortality and secondary endpoints were cardiopulmonary bypass time, extracorporeal membrane oxygenator (ECMO) insertion, low cardiac output, blood product use, and right ventricular functions in the follow‐up. Results Our study had an overall follow‐up of 23 years with a median of 3.18 years. Overall, the in‐hospital mortality rate was 8.54%. Group II had a higher mortality rate (P = .015) and morbidity incidences like cardiopulmonary bypass time (P = .008), ECMO insertion (P = .036), and open chest after surgery (P = .015). Although 5‐year survival was better in group I a compared to group II (81%, 95% CI, 69%‐93% vs 65%, 95% CI, 46%‐84%), the log rank test showed no statistical survival difference among both groups on long‐term follow‐up. Conclusions Long term survival after SPE is good and these results can further be improved by proper PE risk stratification. Alongside computed tomography and echocardiography, the importance of biomarkers like serum lactate can be explored in the PE management algorithm.

Blood lactate predicts mortality after surgical repair of type A acute aortic dissection

“…Serum lactate is a promising pointof-care surrogate marker for malperfusion and it has already been used as a stratification risk parameter in other type of cardiac surgery procedures. 12 Previous studies have shown contrasting results of its correlation with outcomes post-TAAAD repair. 13,14 We aim to investigate the correlation between the serum lactate, in-hospital complications, and 1-year survival after TAAAD surgery.…”

“…Unfortunately, this classification requires many clinical, laboratory and imaging findings, and a swifter and simpler instrument to identify ischemia and malperfusion would be beneficial. Serum lactate is a promising point‐of‐care surrogate marker for malperfusion and it has already been used as a stratification risk parameter in other type of cardiac surgery procedures 12 . Previous studies have shown contrasting results of its correlation with outcomes post‐TAAAD repair 13,14 .…”

Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection

“…Previous studies suggested serum lactate could be used to predict mortality in patients who received cardiac surgeries ( 15 , 16 , 22 ). The lab-based prediction model including preoperative lactate, sCr, and liver malperfusion tests was proposed by Ghoreishi et al ( 23 ) and has been externally validated recently ( 24 ).…”