title: [Hyperlactatemia in surgical ablation of atrial fibrillation and cardiac surgery. Is it a predictive factor of postoperative morbidity?].
abstract: BACKGROUND
  Increased serum lactate in postoperative cardiac surgery is very common and its pathogenesis is due to multiple factors. The elevation of serum lactate is associated with tissue hypoxia (hyperlactatemia type A) and non-hypoxic (hyperlactatemia type B) metabolic disorders. The aim of the study was to assess the evolution of postoperative lactate in surgical atrial fibrillation ablation during cardiac surgery, and to determine whether lactate levels could be predictors of morbimortality.
  
  
  METHODS
  A case-control study was conducted on 32 patients undergoing surgical atrial fibrillation ablation and cardiac surgery (Maze group) and 32 matched patients (Control group), operated on between 2011 and 2012. An analysis was made of the levels of postoperative lactate, perioperative morbimortality and hospital length of stay. A univariate and multivariate study was performed for a composite endpoint of morbimortality, and prolonged length of stay.
  
  
  RESULTS
  Lactate levels were significantly higher at 6, 12 and 24h in the Maze group. The univariate analysis showed that being in the Maze group (OR 3.88; 95% CI 1.3-11.1; P=.01) and an elevated lactate at 12h (OR 1.33; 95% CI 1.01-1.7; P=.04) were significant predictors of major complications, mortality, and longer hospital stays. In the multivariate analysis, surgical atrial fibrillation ablation (Maze group) was an independent predictor of major complications (OR 4.13; 95% CI 1.312.9; P=.015) for the morbimortality composite endpoint (OR 3.9; 95% CI 1.3-11.6; P=.01), and prolonged length of stay in the Intensive Care Unit (OR 5.7; 95% CI 2.01-15.7; P=.01).
  
  
  CONCLUSIONS
  The atrial fibrillation surgical ablation may be a not-yet-described cause of type B hyperlactatemia, with serum peak values being reached between 4-24h after cardiac surgery. The predictive value of this elevation, its correlation with morbimortality, its sensitivity and specificity to discriminate the significant thresholds needs to be defined.
authors.affiliation: Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España.
authors.forename: P
authors.initials: P
authors.lastname: Carmona
authors.affiliation: Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España. Electronic address: mateo_eva@gva.es.
authors.forename: E
authors.initials: E
authors.lastname: Mateo
authors.affiliation: Servicio de Cirugía cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario, Valencia, España.
authors.forename: F
authors.initials: F
authors.lastname: Hornero
authors.affiliation: Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España.
authors.forename: C L
authors.initials: CL
authors.lastname: Errando
authors.affiliation: Servicio de Cirugía cardiaca, Hospital Politécnico La Fe, Valencia, España.
authors.forename: A
authors.initials: A
authors.lastname: Vázquez
authors.affiliation: Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España.
authors.forename: J
authors.initials: J
authors.lastname: Llagunes
authors.affiliation: Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España.
authors.forename: J
authors.initials: J
authors.lastname: De Andrés
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation; D055191:Delayed Emergence from Anesthesia / Q000097:blood / Q000453:epidemiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007773:Lactates / Q000097:blood*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000453:epidemiology
chemical_list: D007773:Lactates
keywords: Ablación de la fibrilación auricular; Atrial fibrillation ablation; Cardiac surgery; Cirugía cardiaca; Complicaciones posoperatorias; Hiperlactatemia; Hyperlactatemia; Lactate; Lactato; Postoperative complications
vernacular_title: Hiperlactatemia en la ablación quirúrgica de la fibrilación auricular y cirugía cardiaca. ¿Es un factor predictivo de morbimortalidad posoperatoria?