Document Detail

Off-pump coronary bypass surgery adversely affects alveolar gas exchange.
MedLine Citation:
PMID:  18494216     Owner:  NLM     Status:  MEDLINE    
While the introduction of off-pump myocardial revascularization (OPCAB) has initially shown promise in reducing respiratory complications inherent to conventional coronary surgery, it has failed to eradicate them. Our study focused on quantifying the lactate release from the lungs and the dysfunction at the level of the alveolar-capillary membrane precipitated by OPCAB at different time points after the insult. Furthermore, we aimed to determine the impact of pulmonary lactate production on systemic lactic acid concentrations. The study was conducted in a prospective observational fashion. Forty consecutive patients undergoing OPCAB were analyzed. The mean patient age was 60 +/- 10 years. The mean EUROScore was 3.8 +/- 2.9. The alveolar-arterial O2 gradient increased from 19 [range 9 to 30] to 26 [range 20 to 34] kPa (P < 0.001) and remained elevated up to 6 hours after surgery. It rapidly declined again by 18 hours postoperatively. The observed increase in the pulmonary lactate release (PLR) from a baseline value of 0.022 [range -0.074 to 0.066] to 0.089 [range 0.016 to 0.209] mmol/min/m2 at six hours postoperatively did not reach statistical significance (P = 0.105). The systemic arterial lactate (Ls) concentration increased from 0.94 [range 0.78 to 1.06] to 1.39 [range 0.97 to 2.81] mmol/L (P < 0.001). The venoarterial pCO2 difference showed no significant change in comparison to baseline values. The mortality in the studied group was 2.5% (1/40). The pulmonary lactate production showed a statistically significant correlation with the systemic lactate concentration (R = 0.46; P = 0.003). Pulmonary injury following off pump myocardial revascularization was evidenced by a prompt increase in the alveolar-arterial oxygen gradient. The alveolar-arterial O2 gradient correlated with the duration of mechanical ventilation.
Hrvoje Gasparović; Daniel Unić; Zeljko Sutlić; Ino Husedzinović; Bojan Biocina; Igor Rudez; Nada Nikić; Ivan Jelić
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Collegium antropologicum     Volume:  32     ISSN:  0350-6134     ISO Abbreviation:  Coll Antropol     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-05-22     Completed Date:  2008-06-25     Revised Date:  2009-02-04    
Medline Journal Info:
Nlm Unique ID:  8003354     Medline TA:  Coll Antropol     Country:  Croatia    
Other Details:
Languages:  eng     Pagination:  293-8     Citation Subset:  IM    
University Hospital Rebro, Zagreb, Croatia.
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MeSH Terms
Coronary Artery Bypass, Off-Pump / adverse effects*
Lactic Acid / biosynthesis
Lung / metabolism
Middle Aged
Pulmonary Gas Exchange*
Reg. No./Substance:
50-21-5/Lactic Acid

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