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Author(s): Alexander Kogan [sup.1], Sergey Preisman [sup.2], Alex Bar [sup.1], Leonid Sternik [sup.1], Jacob Lavee [sup.1], Ateret Malachy [sup.1], Dan Spiegelstein [sup.1], Haim Berkenstadt [sup.2], Ehud Raanani [sup.1] Author Affiliations: [...], Purpose To evaluate the value of blood lactate value in predicting postoperative mortality (primary outcome), duration of ventilation, and length of stay in an intensive care unit (ICU) and hospital (secondary outcomes). Methods We performed a prospective observation study on 1,820 consecutive patients undergoing open heart surgery in a tertiary university medical center. Blood lactate levels were obtained from patients on admission to the cardiac surgical ICU and measured serially. Results All patients were divided into three groups according to their maximum blood lactate levels: group I (normolactatemia, lactate [less than or equal to]2.2 mmol/l), 332 patients; group II (mild hyperlactatemia, lactate 2.2-4.1 mmol/l), 1,054 patients; and group III (severe hyperlactatemia, lactate [greater than or equal to]4.4 mmol/l), 434 patients. Maximum blood lactate levels [greater than or equal to]4.4 mmol/l during the first 10 h post admission were associated with prolonged ventilation time, longer ICU stay, and increased mortality (P < 0.001). Conclusions Hyperlactatemia is common after cardiac surgery. Maximal lactate threshold [greater than or equal to]4.4 mmol/l in the first 10 h after operation accurately predicts postoperative mortality.

Purpose To evaluate the value of blood lactate value in predicting postoperative mortality (primary outcome), duration of ventilation, and length of stay in an intensive care unit (ICU) and hospital (secondary outcomes). Methods We performed a prospective observation study on 1,820 consecutive patients undergoing open heart surgery in a tertiary university medical center. Blood lactate levels were obtained from patients on admission to the cardiac surgical ICU and measured serially. Results All patients were divided into three groups according to their maximum blood lactate levels: group I (normolactatemia, lactate [less than or equal to] 2.2 mmol/l), 332 patients; group II (mild hyperlactatemia, lactate 2.2-4.1 mmol/l), 1,054 patients; and group III (severe hyperlactatemia, lactate [greater than or equal to] 4.4 mmol/l), 434 patients. Maximum blood lactate levels [greater than or equal to] 4.4 mmol/l during the first 10 h post admission were associated with prolonged ventilation time, longer ICU stay, and increased mortality (P < 0.001). Conclusions Hyperlactatemia is common after cardiac surgery. Maximal lactate threshold [greater than or equal to] 4.4 mmol/l in the first 10 h after operation accurately predicts postoperative mortality. Keywords Lactate * Postoperative care * Cardiac anesthesia, Introduction Hyperlactatemia, a well-recognized marker of hypoperfusion, has been associated with mortality in various clinical settings and is a common metabolic disturbance following cardiac surgery. Postoperative blood lactate levels are [...]

We hypothesized that pretreatment of an infarcted heart by mechanical transmyocardial revascularization (TMR) before transplantation of bone marrow cells (BMCs) or BMC-expressing angiogenic growth factors would increase transplanted BMC survival and enhance myocardial repair. Female Lewis rats underwent coronary ligation 3 wk before creation of 10 needle TMR channels (3 groups) or no TMR (3 groups), followed by transplantation of 3 x [10.sup.6] male donor BMCs, BMC transfected with vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and insulin-like growth factor-1 (IGF-1) (BMC + VBI), or medium alone. At 1, 3, and 7 days, we evaluated transplanted cell survival, vascular densities, and left ventricular (LV) function (N = 4 per group x 6 groups x 3 time points). At 3 days, vascular densities in the scar were increased by TMR + BMC + VBI and by BMC + VBI (P < 0.05), and at 7 days, vascular densities were greatest in rats receiving TMR + BMC + VBI (P < 0.05). Transplanted cell survival at 3 and 7 days was increased by TMR and by BMC + VBI. Combined therapy with TMR + BMC + VBI resulted in the greatest cell survival at 3 days (P < 0.05) versus BMC. After 7 days, LV ejection fraction (LVEF) was lowest in rats receiving neither BMC nor TMR and greatest in rats receiving TMR + BMC + VBI (P = 0.004). We concluded that mechanical pretreatment of infarcted myocardium by TMR enhances the effect of subsequent cell-based gene therapy on transplanted cell survival, angiogenesis, and LV function. Scar pretreatment with TMR combined with cell-based multigene therapy may maximize myocardial repair. cell transplantation; angiogenesis