• Rev Esp Cardiol (Engl Ed) · Mar 2019

    Multicenter Study

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

    • David Couto-Mallón, Francisco González-Vílchez, Luis Almenar-Bonet, Beatriz Díaz-Molina, Javier Segovia-Cubero, José González-Costello, Juan Delgado-Jiménez, María A Castel-Lavilla, María G Crespo-Leiro, Diego Rangel-Sousa, Manuel Martínez-Sellés, Gregorio Rábago-Juan-Aracil, Luis De-la-Fuente-Galán, Teresa Blasco-Peiró, Daniela Hervás-Sotomayor, Iris P Garrido-Bravo, Sonia Mirabet-Pérez, Javier Muñiz, and Eduardo Barge-Caballero.
    • Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
    • Rev Esp Cardiol (Engl Ed). 2019 Mar 1; 72 (3): 208-214.

    Introduction And ObjectivesTo study the prognostic value of serum lactate in patients under temporary preoperative mechanical circulatory support who underwent urgent heart transplant.MethodsWe 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.ResultsA 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.ConclusionsPreoperative serum lactate is a strong independent predictor of worse outcomes in patients undergoing urgent heart transplant on short-term mechanical circulatory support.Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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