{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:53:36Z","timestamp":1783464816633,"version":"3.55.0"},"reference-count":24,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute Stanford Type A aortic dissection (ATAAD) is a devastating disease requiring immediate surgery. A life-threatening complication hereby represents organ malperfusion. Lactate is a product of anaerobic glycolysis indicating organ malperfusion. The current study analyzes preoperative lactate acidosis as a surrogate marker for patients\u2019 outcome after surgery for ATAAD over a 15-year period. Methods: In a single-center setting, 306 consecutive patients, who underwent surgery for ATAAD between 2000 and 2016, were analyzed retrospectively. Serum lactate measurements were taken before surgery. To define a simple cut-point of the predictor lactate, the maximally selected rank statistics method was used. Results: Median survival was 9.3 \u00b1 0.5 and CI 95% [8.3\u201310.2] years. Mean lactate levels were 1.95 mmol\/L \u00b1 2.19 mmol\/L (range: 0.15\u201319.27 mmol\/L). Patients with a lactate level &gt; 3.71 mmol\/L had a higher 30-day mortality compared to patients with lactate levels \u2264 3.71 mmol\/L (51.5% versus 18.7%). In a logistic regression model adjusted for clinical baseline characteristics at index procedure, lactate levels &gt; 3.71 mmol\/L reached the highest Odd for 30-day mortality of all tested risk factors (OR = 7.292; CI95% [3.029\u201317.555]; p &lt; 0.0001). Analyzing the overall mortality, the early effect of lactate level &gt; 3.71 mmol\/L persists. The HRs for overall mortality, however, revealed substantially lower effects (HR = 2.772; (CI95% [1.689\u20134.550]; p &lt; 0.0001). In patients who survived the first 30 days postoperatively, no clinical parameter other than age had a significant impact on survival, including lactate &gt; 3.71 mmol\/L (p = 0.494). Conclusions: In patients with ATAAD, preoperative lactate represents an easily obtainable surrogate marker for organ malperfusion. A preoperative lactate level &gt; 3.71 mmol\/L depicts the strongest marker for early mortality after surgery.<\/jats:p>","DOI":"10.3390\/jcm14113619","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T07:04:28Z","timestamp":1747897468000},"page":"3619","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Preoperative Hyperlactatemia Predicts Mortality in Acute Stanford Type A Dissection: A 16-Year-Period, Single-Center, Retrospective Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Nazan","family":"Puluca","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany"},{"name":"Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80333 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2064-9603","authenticated-orcid":false,"given":"Christian","family":"K\u00f6nig","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany"},{"name":"Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80333 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunther","family":"Wiesner","sequence":"additional","affiliation":[{"name":"Institute of Cardioanesthesiology, German Heart Center Munich, Technical University of Munich, 80333 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6365-7972","authenticated-orcid":false,"given":"Birgit","family":"Waschulzik","sequence":"additional","affiliation":[{"name":"Institute for AI and Informatics in Medicine, Technical University of Munich School of Medicine, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8308-7679","authenticated-orcid":false,"given":"Keti","family":"Vitanova","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany"},{"name":"Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80333 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5466-9290","authenticated-orcid":false,"given":"Markus","family":"Krane","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany"},{"name":"Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80333 Munich, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 80636 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5191-0360","authenticated-orcid":false,"given":"Johannes","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany"},{"name":"Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, 80333 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1016\/j.jacc.2020.07.061","article-title":"Type A Aortic Dissection\u2014Experience over 5 Decades: JACC Historical Breakthroughs in Perspective","volume":"76","author":"Zhu","year":"2020","journal-title":"J. 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