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J Thorac Cardiovasc Surg 2005;130:837-843
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Postoperative lactate concentrations predict the outcome of infants aged 6 weeks or less after intracardiac surgery: A cohort follow-up to 18 months

^a Department of Pediatrics, Glenrose Rehabilitation Hospital; Edmonton, Alberta, Canada.
^b Department of Surgery, University of Alberta, Glenrose Rehabilitation Hospital; Edmonton, Alberta, Canada.
^c Child Health Outcomes Unit, Glenrose Rehabilitation Hospital; Edmonton, Alberta, Canada.

Received for publication February 1, 2005; revisions received April 15, 2005; accepted for publication April 25, 2005.

^_* Address for reprints: Dr P-Y Cheung, Department of Newborn Medicine, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, Alberta, Canada T5H 3V9. (Email: poyin{at}ualberta.ca).

OBJECTIVES: An observational cohort study was conducted in infants less than 6 weeks of age undergoing intracardiac surgery to examine the predictive value of serial postoperative lactate determination on survival and early childhood neurodevelopment.

METHODS: A total of 85 infants with congenital heart disease underwent intracardiac surgery between 1996 and 1999. Differences in serial lactate concentrations after surgery among 3 outcome groups were compared. The predictive value of plasma lactate concentration on outcome (1) at discharge from initial hospitalization and (2) 18 to 24 months postnatal age was examined.

RESULTS: Compared with survivors, the nonsurvivors had higher lactate concentrations on admission to the pediatric intensive care unit at day 1 peak and area under the curve of the lactate profile than those of adverse and intact survivors (all P < .001, analysis of variance). Significant differences in the time for lactate concentrations to return to 2 mmol/L or less during the first postoperative day were observed among the groups: nonsurvivors > adverse survivors > intact survivors. Lactate concentrations of less than 7 mmol/L on admission or less than 8 mmol/L at day 1 peak predicted survival with 82% sensitivity and 83% specificity, and positive and negative predictive values of 97% and 43%, respectively (P < .001, ²). Plasma lactate concentrations were associated with adverse outcome but had lower predictive values compared with that for nonsurvival.

CONCLUSIONS: Serial lactate determination accurately predicts survival and may help differentiate survivors with adverse outcome from those with intact neurodevelopment in early childhood.

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