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J Thorac Cardiovasc Surg 2010;139:170-173
© 2010 The American Association for Thoracic Surgery

Perioperative Management

Cardiopulmonary bypass flow rate: A risk factor for hyperlactatemia after surgical repair of secundum atrial septal defect in children

Boban P. Abraham, MDa,f, Parthak Prodhan, MBBSa,b,f, Robert D.B. Jaquiss, MDc,f, Adnan T. Bhutta, MDa,b,f, Jeffrey M. Gossett, MSd,f, Michiaki Imamura, MD, PhDc,f, Charles E. Johnson, RN, CCPc,f, Michael L. Schmitz, MDa,c,e,f, William R. Morrow, MDa,b,f, Umesh Dyamenahalli, MDa,b,f,*

a Department of Pediatrics, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
b Section of Pediatric Cardiology, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
c Section of Pediatric Cardiothoracic Surgery, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
d Department of Biostatistics, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
e Section of Pediatric Cardiothoracic Anesthesia, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
f Arkansas Children's Hospital, Little Rock, Ark

Received for publication December 23, 2008; revisions received April 2, 2009; accepted for publication April 22, 2009.

* Address for reprints: Umesh Dyamenahalli, MD, 1 Children's Way, 512-3, Little Rock, AR 72202. (Email: Dyamenahalliumesh{at}uams.edu).

Objective: Early postoperative hyperlactatemia is seen in some children after surgical repair of secundum atrial septal defect despite apparently normal cardiac output. The objective of the study was to investigate the intraoperative risk factors for hyperlactatemia in patients undergoing atrial septal defect repair.

Methods and Results: A retrospective review of 68 consecutive patients who underwent isolated atrial septal defect repair at Arkansas Children's Hospital between January 2001 and March 2006 was performed. Perioperative factors in the high lactate group (lactate >3 mmol/L, n = 26) were compared with those in the low lactate group (n = 42). Early hyperlactatemia was seen in 38% of the cohort. The high lactate group showed significantly lower weight-indexed cardiopulmonary bypass flow rate (101 ± 6.5 mL/kg–1/min–1 vs 131 ± 6.0 mL/kg–1/min–1, P = .0013), oxygen delivery during cardiopulmonary bypass (mean 12.7 ± 0. 7 mL/kg–1/min–1 vs 17.0 ± 1 mL/kg–1/min–1, P = .0009), and higher postoperative glucose (191 ± 8.6 mg/dL vs 151 ± 5.4 mg/dL, P = .003) compared with the LL group. Multivariate logistic regression analysis showed that weight-indexed cardiopulmonary bypass flow rate (P = .007) and average mean arterial blood pressure during cardiopulmonary bypass (P = .009) were independent risk factors for postoperative hyperlactatemia. Cardiopulmonary bypass flow rate less than 100 mL/kg–1/min–1 was associated with an odds ratio of 7.67 (95% confidence interval, 1.28–45.86; P = .026) for postoperative hyperlactatemia.

Conclusion: Lower weight-indexed cardiopulmonary bypass flow rate is an independent risk factor for early postoperative hyperlactatemia in children after atrial septal defect repair.

Abbreviations and Acronyms ASD = atrial septal defect; CPB = cardiopulmonary bypass; HL = high lactate (group); LL = low lactate (group)


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