Abstract

IntroductionCardiopulmonary bypass (CPB) is associated with hyperlactatemia, which leads to adverse clinical outcomes. No study has examined the effect of different clamping techniques on postoperative hyperlactatemia (PHL). Thus, we aimed to evaluate the impact of two different techniques on PHL and the clinical outcomes in patients undergoing isolated coronary artery bypass surgery.MethodsThis retrospective study included 100 patients who underwent isolated CPB either with single clamp technique (SCT, n=47) or double clamp technique (DCT, n=53). Demographic and preoperative laboratory data, as well as operative features and arterial blood lactate levels at the onset and at the end of CPB, were collected from patient charts.ResultsBlood lactate levels collected at the end of CPB did not differ significantly between groups whereas intraoperative lactate increased significantly in both groups (P<0.005). PHL developed in 16 patients (32%). There was no meaningful difference in SCT and DCT in this regard. Left internal mammary artery was used more frequently in the DCT group than in the SCT group. While the cross-clamp time was significantly longer in the SCT group, there was no difference regarding CPB time. Among postoperative complications, only the incidence of stroke was significantly higher in the DCT group than in the SCT group (10.6% vs. 0%, P=0.020). CPB time, cross-clamp time and numbers of proximal saphenous graft and distal anastomosis showed a significant positive correlation with the postoperative lactate level. In the regression analysis, CPB time emerged as the only independent predictor of PHL (OR 1.04, CI 95% 1.01-1.07, P=0.011).ConclusionThere was no difference in postoperative blood lactate levels between SCT and DCT groups.

Highlights

  • Cardiopulmonary bypass (CPB) is associated with hyperlactatemia, which leads to adverse clinical outcomes

  • There was no difference between the groups in terms of age, gender, frequency of comorbidities, ejection fraction, glomerular filtration rate, and other laboratory parameters except hypertension, which was significantly higher in the double clamp technique (DCT) group

  • Since proximal anastomoses were performed with XCL in the single clamp technique (SCT) group, cross-clamp time was significantly longer in the SCT group compared to the DCT group (80.4±25.6 vs. 63.7±21.1 min, P

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Summary

Introduction

Cardiopulmonary bypass (CPB) is associated with hyperlactatemia, which leads to adverse clinical outcomes. No study has examined the effect of different clamping techniques on postoperative hyperlactatemia (PHL). We aimed to evaluate the impact of two different techniques on PHL and the clinical outcomes in patients undergoing isolated coronary artery bypass surgery. The blood lactate level under normal physiological conditions is stable and balanced. Several pathophysiological conditions impair this balance and, cause hyperlactatemia and acidosis[1]. Open-heart surgery, when carried out with cardiopulmonary bypass (CPB), is associated with the development of hyperlactatemia[1]. The hyperlactatemia seen in patients undergoing CPB is multifactorial. Several studies have clearly shown that hyperlactatemia is associated with poorer postoperative clinical outcomes on different types of heart surgery[2]

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