Perioperative assessment of cardiac energy metabolism by means of arterio-coronary venous difference in lactate concentration (acDL) A parameter for optimizing ventricular function of the postcardioplegic myocardium

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Abstract
Fourty-three patients undergoing open heart surgery were subjected toextended hemodynamic and metabolic monitoring (arterial and coronary sinus(CS) lactate concentration). In 95% of patients investigated, a significantincrease in CS lactate concentration above the arterial lactateconcentration was established at the beginning of reperfusion (RPT). Inthese cases, a decrease in the CS lactate below the arterial concentrationoccurs within the RPT creating a cross-over point (COP) from negative topositive lactate extraction values. Whereas the initial rise in CS lactateis an expression of the expected ischemia- induced acceleration ofanaerobic glycolysis, the onset of a positive lactate extraction can berelated to reconsolidation of mitrochondrial oxidative phosphorylation. Wefound two groups with an early and late COP at 7.2 +/- 0.8 min (ECOP) and42.5 +/- 5.2 min (LCOP) (P less than 0.005). Whereas a short cross-overtime was associated with a normal postoperative outcome, cardiac recoverywas delayed in the LCOP group. With the aid of metabolic monitoring it ispossible to identify the COP and cardiac overload situations and so tooptimize the perioperative outcome, especially in selected patients (NYHAstage III/IV, re- operation, high-risk operation).

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