Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2019;72:208-14 - Vol. 72 Num.03 DOI: 10.1016/j.rec.2018.02.021

Prognostic Value of Serum Lactate Levels in Patients Undergoing Urgent Heart Transplant: A Subanalysis of the ASIS-TC Spanish Multicenter Study

David Couto-Mallón a,b, Francisco González-Vílchez c, Luis Almenar-Bonet d, Beatriz Díaz-Molina b,e, Javier Segovia-Cubero b,f, José González-Costello g, Juan Delgado-Jiménez b,h, María A. Castel-Lavilla b,i, María G. Crespo-Leiro a,b, Diego Rangel-Sousa j, Manuel Martínez-Sellés b,k, Gregorio Rábago-Juan-Aracil l, Luis De-la-Fuente-Galán m, Teresa Blasco-Peiró n, Daniela Hervás-Sotomayor o, Iris P. Garrido-Bravo p, Sonia Mirabet-Pérez q, Javier Muñiz b,r, Eduardo Barge-Caballero a,b,

a Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
c Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
d Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
e Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
f Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
g Servicio de Cardiología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
h Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
i Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
j Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
k Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
l Servicio de Cirugía Cardiaca, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
m Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain
n Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
o Servicio de Cirugía Cardiovascular, Hospital Universitario Reina Sofía, Córdoba, Spain
p Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
q Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
r Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

Keywords

Lactate. Heart transplant. Mechanical circulatory support.

Abstract

Introduction and objectives

To study the prognostic value of serum lactate in patients under temporary preoperative mechanical circulatory support who underwent urgent heart transplant.

Methods

We conducted a subanalysis of a Spanish multicenter registry recording data on patients under temporary mechanical circulatory support listed for highly urgent heart transplant from 2010 to 2015. Participants selected for the present study were those who received a transplant and who had known preoperative serum lactate levels. The main study outcome was 1-year survival after transplant.

Results

A total of 177 heart transplant recipients were studied; preoperatively, 90 were supported on venoarterial extracorporeal membrane oxygenation, 51 on temporary left ventricular assist devices, and 36 on temporary biventricular assist devices. Preoperative hyperlactatemia (≥ 2 mmol/L) was present in 44 (25%) patients. On multivariable analysis, pretransplant serum lactate was identified as an independent predictor of 1-year posttransplant survival (adjusted HR per 0.1 mmol/L, 1.02; 95%CI, 1.01-1.03; P = .007). One-year posttransplant survival was 53.1% (95%CI, 45.3-60.9) in patients with preoperative hyperlactatemia and 75.6% (95%CI, 71.8-79.4) in those without preoperative hyperlactatemia (adjusted HR, 1.94; 95%CI, 1.04-3.63; P = .039). Preoperative hyperlactatemia correlated with adverse outcomes in patients supported with extracorporeal membrane oxygenation, but not in patients supported on ventricular assist devices.

Conclusions

Preoperative serum lactate is a strong independent predictor of worse outcomes in patients undergoing urgent heart transplant on short-term mechanical circulatory support.

Article

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1885-5857/© 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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