BACKGROUND: Lactic acidosis (LAc) is a common form of metabolic acidosis early after heart transplantation (HTX). The mechanism remains unclear. This study analyzed 13 patients who developed severe LAc after HTX. METHODS: From a series of 60 consecutive heart transplant patients, we identified 13 patients with LAc in the first hours following HTX. Nine patients with normal or mildly elevated lactate levels (<5.0 mmol/l) were investigated as controls. RESULTS: Thirteen patients developed a moderate or severe LAc (up to 14.6 mmol/l) after HTX. Serum lactate levels increased immediately following surgery with a peak after 6.3+/-1.4 h, spontaneously returning to normal values within 24 h. In contrast to the control group, a significant correlation was found between the maximal serum lactate level and the maximal dosage of inotropic drugs (r=0.93, P<0.02), administered during the reperfusion phase and continued for 12-24 h postoperatively. No correlation was found between LAc and blood gas analysis during extracorporeal perfusion period. CONCLUSION: LAc can occur after HTX and seems to be related to the inotropic support of the graft. In contrast to other forms, LAc after HTX has an excellent prognosis and resolves rapidly and spontaneously without treatment. The fact that inotropic support during and immediately after cardiac transplantation can enhance preexisting severe peripheral metabolic cellular dysfunction remains hypothetical.
BACKGROUND:Lactic acidosis (LAc) is a common form of metabolic acidosis early after heart transplantation (HTX). The mechanism remains unclear. This study analyzed 13 patients who developed severe LAc after HTX. METHODS: From a series of 60 consecutive heart transplant patients, we identified 13 patients with LAc in the first hours following HTX. Nine patients with normal or mildly elevated lactate levels (<5.0 mmol/l) were investigated as controls. RESULTS: Thirteen patients developed a moderate or severe LAc (up to 14.6 mmol/l) after HTX. Serum lactate levels increased immediately following surgery with a peak after 6.3+/-1.4 h, spontaneously returning to normal values within 24 h. In contrast to the control group, a significant correlation was found between the maximal serum lactate level and the maximal dosage of inotropic drugs (r=0.93, P<0.02), administered during the reperfusion phase and continued for 12-24 h postoperatively. No correlation was found between LAc and blood gas analysis during extracorporeal perfusion period. CONCLUSION: LAc can occur after HTX and seems to be related to the inotropic support of the graft. In contrast to other forms, LAc after HTX has an excellent prognosis and resolves rapidly and spontaneously without treatment. The fact that inotropic support during and immediately after cardiac transplantation can enhance preexisting severe peripheral metabolic cellular dysfunction remains hypothetical.
Authors: Hong Rae Kim; Sung-Ho Jung; Junho Yang; Min Su Kim; Tae-Jin Yun; Jae-Joong Kim; Jae Won Lee Journal: Korean J Thorac Cardiovasc Surg Date: 2020-12-05
Authors: Louise E See Hoe; Karin Wildi; Nchafatso G Obonyo; Nicole Bartnikowski; Charles McDonald; Kei Sato; Silver Heinsar; Sanne Engkilde-Pedersen; Sara Diab; Margaret R Passmore; Matthew A Wells; Ai-Ching Boon; Arlanna Esguerra; David G Platts; Lynnette James; Mahe Bouquet; Kieran Hyslop; Tristan Shuker; Carmen Ainola; Sebastiano M Colombo; Emily S Wilson; Jonathan E Millar; Maximillian V Malfertheiner; Janice D Reid; Hollier O'Neill; Samantha Livingstone; Gabriella Abbate; Noriko Sato; Ting He; Viktor von Bahr; Sacha Rozencwajg; Liam Byrne; Leticia P Pimenta; Lachlan Marshall; Lawrie Nair; John-Paul Tung; Jonathan Chan; Haris Haqqani; Peter Molenaar; Gianluigi Li Bassi; Jacky Y Suen; David C McGiffin; John F Fraser Journal: Intensive Care Med Exp Date: 2021-12-24