Impact of perioperative dexmedetomidine treatment on 1-year mortality in patients undergoing orthotopic heart transplantation

BJA open Pub Date : 2025-03-14 DOI:10.1016/j.bjao.2025.100389

Carolin Torregroza , Carla L. Endreß , René M'Pembele , Sebastian Roth , Alexandra Stroda , Hug Aubin , Artur Lichtenberg , Giovanna Lurati Buse , Ragnar Huhn , Udo Boeken

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Abstract

Background

Heart transplantation remains the gold standard treatment of end stage heart failure. The prognosis of heart transplantation has continuously improved, with a 10-yr survival of 53%. Dexmedetomidine is commonly used as a sedative in cardiac patients. Recently its clinical use has been limited because it was associated with increased mortality in the SPICE 3 trial. The impact of perioperative dexmedetomidine treatment on patients undergoing heart transplantation has not been examined yet. Therefore, this study investigated the influence of dexmedetomidine treatment on 1-yr mortality in patients undergoing heart transplantation.

Methods

This retrospective cohort study included patients who underwent heart transplantation at the University Hospital Duesseldorf between 2011 and 2021. The main exposure was perioperative dexmedetomidine treatment. The primary endpoint was 1-yr mortality after surgery. Kaplan–Meier analysis and multivariate cox regression with adjustment for risk index for mortality prediction after cardiac transplantation (IMPACT) and packed red blood cells were performed.

Results

A total of 267 patients were screened. To avoid a potential selection bias, patients who needed postoperative treatment with extracorporeal life support system were excluded, leaving 169 patients included in the analysis. Out of 169 patients, 85 received perioperative dexmedetomidine treatment and 84 were not treated with dexmedetomidine. Overall, 1-yr mortality was 10.3% (dexmedetomidine 4.9% vs no dexmedetomidine 15.5%, P=0.025). After adjustment for IMPACT score and packed red blood cells, dexmedetomidine treatment was independently associated with lower 1-yr mortality after heart transplantation (hazard ratio: 0.25, 95% confidence interval 0.07–0.93, P=0.03).