BACKGROUND: Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD. METHODS: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery. RESULTS: Data on arterial lactate concentration immediately before surgery were available in 2798 (71.7 %) patients. Preoperative concentration of arterial lactate was an independent predictor of in-hospital mortality (mean, 3.5 ± 3.2 vs 2.1 ± 1.8 mmol/L, adjusted OR 1.181, 95%CI 1.129-1.235). The best cutoff value preoperative arterial lactate concentration was 1.8 mmol/L (in-hospital mortality, 12.0 %, vs. 26.6 %, p < 0.0001). The rates of in-hospital mortality increased along increasing quintiles of arterial lactate and it was 12.1 % in the lowest quintile and 33.6 % in the highest quintile (p < 0.0001). The difference between multivariable models with and without preoperative arterial lactate was statistically significant (p = 0.0002). The NRI was 0.296 (95%CI 0.200-0.391) (p < 0.0001) with -17 % of events correctly reclassified (p = 0.0002) and 46 % of non-events correctly reclassified (p < 0.0001). The IDI was 0.025 (95%CI 0.016-0.034) (p < 0.0001). Six studies from a systematic review plus the present one provided data for a pooled analysis which showed that the mean difference of preoperative arterial lactate between 30-day/in-hospital deaths and survivors was 1.85 mmol/L (95%CI 1.22-2.47, p < 0.0001, I2 64 %). CONCLUSIONS: Hyperlactatemia significantly increased the risk of mortality after surgery for acute TAAD and should be considered in the clinical assessment of these critically ill patients.

Cardiac Surgery Molinette Hospital University of Turin Turin Italy

Cardiothoracic Department University Hospital Udine Italy

Cardiovascular Surgery Department University Hospital Gregorio Marañón Madrid Spain

Center for Global Health National Health Institute Rome Italy

Centre Hospitalier Annecy Genevois France

Department of Cardiac Surgery 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Cardiac Surgery Centre Cardiologique du Nord de Saint Denis Paris France

Department of Cardiac Surgery Glenfield Hospital Leicester United Kingdom

Department of Cardiac Surgery Hôpitaux Universitaires Henri Mondor Assistance Publique Hôpitaux de Paris Creteil France

Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany

Department of Cardiovascular Surgery Hospital Clínic de Barcelona University of Barcelona Spain

Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta Finland

Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon France

Division of Cardiac Surgery Cardio thoracic and Vascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste Italy

Division of Cardiac Surgery University of Verona Medical School Verona Italy

German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany

Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital Liverpool United Kingdom

LMU University Hospital Ludwig Maximilian University Munich Germany

Research Unit of Surgery Anesthesia and Critical Care University of Oulu Oulu Finland

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