Preoperative and intraoperative metabolic state, expressed by lactatemia, may influence outcome even in severe vascular damage and major surgery. The aim of the study is the identification of risk factors, included lactatemia, for postoperative complications, 30 days mortality and long term mortality in patients surgically treated for type A aortic dissection.
A total of 75 consecutive patients operated on for type A aortic dissection from January 2013 to December 2017, were considered for three end-points: postoperative complications, 30 days mortality and long term mortality. Univariate analysis, logistic regression, Cox proportional hazard logistic regression and Kaplan-Meier analysis were conducted.
Operative mortality was 0%. Determinants of complicated postoperative stay were identified as preoperative neurological damage and oligo-anuria; 30-days mortality (8 patients, 10.7%) was related to preoperative and intraoperative hyperlactatemia (>4mmol/L, preoperative critical hemodynamic state and permanent postop neurological damage; long term mortality (16 patients, 21.3%, follow-up max 1857, median 785 days) resulted associated with age, renal failure and intraoperative hyperlactatemia (>8 mmol/L). A subanalysis identified renal failure to be related to intraoperative hyperlactatemia (>8mmol/L). No significant role has been found for CPB and cross-clamp time.
Mortality rate was low. Age, renal failure, preoperative and intraoperative hyperlactatemia, preoperative critical status and preoperative and postoperative neurological damage resulted associated with poor outcome. The role of metabolic state, expressed by lactatemia, is directly and indirectly emerging as a crucial factor influencing the outcome. Although it is expression of a catastrophic vascular event, effort has to be made to minimize metabolic stress.
1Dip Medicina e Chirurgia, Univ Insubria and SC Cardiochirurgia, ASST Settelaghi Varese
2Dip Medicina e Chirurgia, Univ Insubria Varese
3SC Cardiochirurgia, Dip Medicina e Chirurgia, Univ Insubria Varese
4SC Cardiochirurgia, Dip Scienze Cardiologiche, ASST Settelaghi Varese
5Dip Medicina e Chirurgia, Univ Insubria and Chief of SC Cardiochirurgia, ASST Settelaghi Varese