Risk stratification using serum lactate in patients undergoing surgical pulmonary embolectomy.
Adolescent
Adult
Aged
Biomarkers
/ blood
Cardiopulmonary Bypass
Embolectomy
/ methods
Female
Hospital Mortality
Humans
Lactates
/ blood
Male
Middle Aged
Operative Time
Pulmonary Embolism
/ diagnosis
Retrospective Studies
Risk Assessment
/ methods
Survival Rate
Time Factors
Treatment Outcome
Young Adult
angina
deep vein thrombosis
dialysis
shock
thrombosis
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
pubmed:
1
7
2020
medline:
3
11
2020
entrez:
30
6
2020
Statut:
ppublish
Résumé
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). 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Substances chimiques
Biomarkers
0
Lactates
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1531-1538Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med. 2010;363(3):266-274.
Keeling WB, Leshnower BG, Lasajanak Y, et al. Midterm benefits of surgical pulmonary embolectomy for acute pulmonary embolus on right ventricular function. J Thorac Cardiovasc Surg. 2016;152:872-878.
Corsi F, Lebreton G, Bréchot N, et al. Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation. Crit Care. 2017;21:76.
Konstantinides SV, Meyer G, Becattini C, et al. ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism Developed in Collaboration with the European Respiratory Society (ERS): the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2019;41(4):543-603.
Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care. 2010;14:R25.
Edelman JJ, Okiwelu N, Anvardeen K, et al. Surgical pulmonary embolectomy: experience in a series of 37 consecutive cases. Heart, Lung Circ. 2016;25:1240-1244.
Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systemic review. Scand J Trauma Resusc Emerg Med. 2011;19:74.
Kalra R, Bajaj NS, Arora P, et al. Surgical embolectomy for acute pulmonary embolism: systemic review and comprehensive meta-analyses. Ann Thorac Surg. 2017;103:982-990.
Neely RC, Byrne JG, Gosev I, et al. Surgical embolectomy for acute massive and submassive pulmonary embolism in a series of 115 patients. Ann Thorac Surg. 2015;100:1245-1251.
Minton J, Sidebotham DA. Hyperlactatemia and cardiac surgery. J Extra Corpor Technol. 2017;49:7-15.
Perrier A, Roy PM, Aujesky D, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. 2004;116:291-299.
Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation. 2007;116:427-433.
Kucher N, Goldhaber SZ. Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism. Circulation. 2003;108:2191-2194.
Fiumara K, Kucher N, Fanikos J, Goldhaber SZ. Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism. Am J Cardiol. 2006;97:127-129.
Lee T, Itagaki S, Chiang YP, Egorova NN, Adams DH, Chikwe J. Survival and recurrence after acute pulmonary embolism treated with pulmonary embolectomy or thrombolysis in New York State, 1999 to 2013. J Thorac Cardiovasc Surg. 2018;155(3):1084-1090.
Takahashi H, Okada K, Matsumori M, Kano H, Kitagawa A, Okita Y. Aggressive surgical treatment of acute pulmonary embolism with circulatory collapse. Ann Thorac Surg. 2012;94:785-791.
Ikuo F, Kazuyuki D. Surgical embolectomy for acute pulmonary thromboembolism. Ann Vasc Dis. 2017;10(2):107-114.
Stein PD, Alnas M, Beemath A, Patel NR. Outcome of pulmonary embolectomy. Am J Cardiol. 2007;99:421-423.
Keeling WB, Sundt T, Leacche M, et al. SPEAR working group. Outcomes after surgical pulmonary embolectomy for acute pulmonary embolus: a multi-institutional study. Ann Thorac Surg. 2016;102:1498-1502.
Bou Chebl R, El Khuri C, Shami, et al. Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department. A retrospective study. Scand J Trauma Resusc Emerg Med. 2017;25:69.