Lactate Metabolism and Monitoring in Cardiac Surgery

Lactate is a central metabolite in energy metabolism, formed from pyruvate under conditions of limited oxygen availability. In cardiac surgery, factors such as cardiopulmonary bypass, haemodilution and perioperative low cardiac output can precipitate tissue hypoxia and lead to accumulation of lactate (type A hyperlactataemia). Beyond reflecting anaerobic metabolism, elevated lactate may also arise from stress-induced adrenergic stimulation and deranged gluconeogenesis (type B hyperlactataemia). Serial measurement of blood lactate levels and kinetic analysis of rise and clearance provide real-time insight into the balance between tissue oxygen delivery and metabolic demand. Persistent or rapidly rising lactate concentrations in the immediate postoperative period have been associated with increased morbidity, prolonged intensive care unit stay and higher risk of complications such as low cardiac output syndrome, organ dysfunction and neurological sequelae. Advances in point-of-care testing and continuous monitoring technologies offer the potential for earlier detection of perfusion deficits and tailored haemodynamic interventions. Understanding individual patient trajectories of lactate production and elimination is key to optimising perfusion strategies, guiding inotropic support and improving global outcomes in diverse patient populations—including adults, paediatric cohorts and heart transplant recipients.

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Lactate Metabolism and Monitoring in Cardiac Surgery publication trend

The graph below shows the total number of articles in lactate metabolism and monitoring in cardiac surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Lactate: A three-carbon metabolite produced from pyruvate under low-oxygen conditions, reflecting anaerobic glycolysis.

Hyperlactataemia: A state in which blood lactate concentration exceeds normal thresholds (commonly >2 mmol/L), indicating impaired tissue oxygenation or altered metabolism.

Cardiopulmonary bypass (CPB): A mechanical system that temporarily takes over cardiac and pulmonary function during open-heart surgery, affecting perfusion and oxygen delivery.

Point-of-care testing: Bedside laboratory measurement allowing rapid assessment of biomarkers such as lactate to guide immediate clinical decisions.

References

1. Association Between the Highest Lactate Level on the First Postoperative Day and Postoperative Delirium in Cardiac Surgery Patients. CNS Neuroscience & Therapeutics (2025).
2. A Rapid Increase in Serum Lactate Levels after Cardiovascular Surgery Is Associated with Postoperative Serious Adverse Events: A Single Center Retrospective Study. Diagnostics (2024).
3. Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome. Critical Care (2006).
4. Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: a matched cohort study. Journal of Cardiothoracic Surgery (2016).
5. Hyperlactatemia in critical illness and cardiac surgery. Critical Care (2010).
6. Central venous oxygen saturation and blood lactate levels during cardiopulmonary bypass are associated with outcome after pediatric cardiac surgery. Critical Care (2010).
7. Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia. PLOS ONE (2015).
8. Postoperative hyperlactatemia and serum lactate level trends among heart transplant recipients. PeerJ (2020).