[Interest of D-lactate as a colic hypoperfusion marker during aortic abdominal aneurysm surgery]

Abstract

Objective: D-lactate is the dextrogyre form of the lactate usually measured in intensive care. Its bacterial origin should make it a marker of translocation during gut ischemia. The aim was to test D-lactate as a postoperative marker of colic hypoperfusion measured during aortic surgery.

Study design: Prospective observational cohort study.

Patients and measurements: Patients operated for abdominal aortic aneurysm. Two groups were stratified on inferior mesenteric arterial residual pressure (IMArP) measured during the surgery: Colic hypoperfusion during surgery (CHs) group: patients with an IMArP < 40 mmHg.

Control group: patients with an IMArP > or = 40 mmHg. Baseline data such as age, duration of aortic clamping and severity score (IGS II) were collected. The D-lactate was measured in postoperative at admission time in ICU and then daily. D-lactate(max) defined the maximum value of D-lactate for one patient.

Main results: Twenty-nine patients were included, 23 in the control group and 6 in the CHs group. Groups were comparable at baseline. D-lactate(max) was significantly higher in the CHs group (median: 0.13 mmol/l; min-max: 0.03-0.9 mmol/l) than in the control group (0.03; 0-0.26 mmol/l, p=0.007).

Conclusion: D-lactate could be postoperative marker of colic hypoperfusion measured during surgery for abdominal aortic aneurysm.