Prognostic Value Of Serum Lactate Level In Coronary Artery Bypass Surgery: A Comparison Between Conventional And Minimally Invasive Procedures
Mohamed Alaa1, Mohamed AbdulWahab Al Assal2, Mohamed Nasser Aldahmashi2, Atef Farag2, Arto Nemlander2.
1Faculty of Medicine, Suez Canal University, Ismailia, Egypt, 2Ministry of Health, PAAM Cardiac Center, Arar, Saudi Arabia.
Background and Aim: Minimally invasive cardiac surgery (MICS) has been increasingly employed by cardiac surgeons worldwide, it necessitates a prognostic factor to evaluate the efficacy of this type of surgery beside its proven shorter hospitalization periods and quicker return to preoperative baseline for patients. Postoperative lactate level has been considered a marker of intraoperative ischaemia. which can affect prognosis. Our study aims to compare the immediate postoperative serum lactate levels of patients who had undergone MICS and others with a conventional full sternotomy procedure (open-CABG). Methods: The data of 321 patients (261 open-CABG, 60 MICS-CABG) from a mixed Arab and Asian population who underwent CABG operated by a single surgical team at a national periphery-center between 2017 to 2019 were retrospectively analyzed. Ten patients were excluded due to missing data. A generalized structural equation model was constructed and applied for data analysis, with all statistical tests performed with 95% confidence intervals (CIs). The model factored in blood tests, Charlson comorbidity index, and nature of the operation. Results: The average post-op serum lactate level in both groups was 3.27 (range 0.54-14.70). Patients who underwent MICS had a significantly lower post-op lactate level (coefficient −1.10; 95% CI −1.82 to −0.39 [p = .003]). A unit increment in lactate level was associated with a 11.6% increase in the odds of developing a new onset arrhythmia in early post-op period (adjusted odds ratio 1.12; 95% CI 1.00-1.26 [p = .054]). Conclusions: Patients who had MICS-CABG could have better prognosis with lower early postoperative lactate levels and lower probability of developing postoperative arrhythmia. Patients whom eligibility suits both procedures might benefit more from the MICS approach.
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