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).

Conclusion

Perioperative dexmedetomidine treatment appears to be safe regarding 1-yr mortality in patients undergoing orthotopic heart transplantation.

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围手术期右美托咪定治疗对心脏移植患者 1 年死亡率的影响

背景：心脏移植仍然是终末期心力衰竭的金标准治疗方法。心脏移植预后不断改善，10年生存率为53%。右美托咪定常用作心脏病人的镇静剂。最近它的临床应用受到限制，因为在SPICE 3试验中它与死亡率增加有关。右美托咪定对心脏移植患者围手术期的影响尚未见报道。因此，本研究探讨右美托咪定治疗对心脏移植患者1年死亡率的影响。方法本回顾性队列研究纳入2011年至2021年间在杜塞尔多夫大学医院接受心脏移植的患者。主要暴露于围手术期右美托咪定治疗。主要终点是术后1年死亡率。进行Kaplan-Meier分析和多变量cox回归，校正心脏移植后死亡率预测风险指数（IMPACT）和红细胞堆积。结果共筛选患者267例。为了避免潜在的选择偏倚，排除了术后需要体外生命支持系统治疗的患者，留下169例患者纳入分析。169例患者中，85例接受了围手术期右美托咪定治疗，84例未接受右美托咪定治疗。总体而言，1年死亡率为10.3%（右美托咪定4.9% vs未右美托咪定15.5%，P=0.025）。在调整IMPACT评分和红细胞填充后，右美托咪定治疗与心脏移植术后1年死亡率降低独立相关（风险比：0.25,95%可信区间0.07-0.93，P=0.03）。结论右美托咪定治疗对原位心脏移植患者的1年死亡率是安全的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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