title: Hyperlactemia Predicts Surgical Mortality in Patients Presenting With Acute Stanford Type-A Aortic Dissection.
abstract: OBJECTIVE
  Inspired by the limited facility of the Penn classification, the authors aimed to determine a rapid and optimal preoperative assessment tool to predict surgical mortality after acute Stanford type-A aortic dissection (AAAD) repair.
  
  
  METHODS
  Patients who underwent an attempted surgical repair of AAAD were determined using a de-identified single institution database. The charts of 144 patients were reviewed retrospectively for preoperative demographics and surrogates for disease severity and malperfusion. Bivariate analysis was used to determine significant (p≤0.05) predictors of in-hospital and 1-year mortality, the primary endpoints. Receiver operating characteristic curve generation was used to define optimal cut-off values for continuous predictors.
  
  
  METHODS
  Single center, level 1 trauma, university teaching hospital.
  
  
  METHODS
  The study included 144 cardiac surgical patients with acute type-A aortic dissection presenting for surgical correction.
  
  
  METHODS
  Surgical repair of aortic dissection with preoperative laboratory samples drawn before patient transfer to the operating room or immediately after arterial catheter placement intraoperatively.
  
  
  RESULTS
  The study cohort comprised 144 patients. In-hospital mortality was 9%, and the 1-year mortality rate was 17%. Variables that demonstrated a correlation with in-hospital mortality included an elevated serum lactic acid level (odds ratio [OR] 1.5 [1.3-1.9], p<0.001), a depressed ejection fraction (OR 0.91 [0.86-0.96], p = .001), effusion (OR 4.8 [1.02-22.5], p = 0.04), neurologic change (OR 5.3 [1.6-17.4], p = 0.006), severe aortic regurgitation (OR 8.2 [2.0-33.9], p = 0.006), and cardiopulmonary resuscitation (OR 6.8 [1.7-26.9], p = 0.01). Only an increased serum lactic acid level demonstrated a trend with 1-year mortality using univariate Cox regression (hazard ratio 1.1 [1.0-1.1], p = 0.006). Receiver operating characteristic analysis revealed optimal cut-off lactic acid levels of 6.0 mmol/L and 6.9 mmol/L for in-hospital and 1-year mortality, respectively.
  
  
  CONCLUSIONS
  Lactic acidosis, ostensibly as a surrogate for systemic malperfusion, represents a novel, accurate, and easily obtainable preoperative predictor of short-term mortality after attempted AAAD repair. These data may improve identification of patients who would not benefit from surgery.
authors: Division of Cardiovascular Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. Electronic address: Jeremy.m.bennett@vanderbilt.edu.
authors: Jeremy M
authors: JM
authors: Bennett
authors: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors: Eric S
authors: ES
authors: Wise
authors: Biomedical Engineering Department, Vanderbilt University Medical Center, Nashville, TN.
authors: Kyle M
authors: KM
authors: Hocking
authors: Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors: Colleen M
authors: CM
authors: Brophy
authors: Division of Cardiovascular Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
authors: Susan S
authors: SS
authors: Eagle
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D065906:Hyperlactatemia / Q000150:complications / Q000175:diagnosis*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: aortic dissection; hyperlactemia; lactic acidosis; metabolic acidosis; surgical mortality