Which is the most comprehensive single marker of adequate myocardial recovery after CPB separation?

• A. Stable blood pressure and cardiac output.
• B. Persistent lactic acidosis.
• C. SvO2 increasing beyond baseline.
• D. Worsening contractility.

Answer: (A)

After separating from CPB, the heart’s ability to sustain effective systemic perfusion is the primary concern. Stable blood pressure with adequate cardiac output best captures this, because it directly shows the heart is delivering enough pump performance to maintain perfusion pressures and end-organ flow. If both remain steady, the myocardium is functioning well enough to support the patient without ongoing support.

Other indicators can be misleading on their own. Persistent lactic acidosis may reflect prior hypoperfusion or other factors and doesn’t guarantee current recovery. A mixed venous oxygen saturation higher than baseline can be affected by changes in oxygen delivery and extraction, not necessarily improved myocardial function. Worsening contractility clearly indicates poor recovery.