Raven Lisa M, Muir Christopher A, Deveza Ricardo C, Kessler Iglesias Cassia, Bart Nicole K, Muthiah Kavitha, Kotlyar Eugene, Hayward Christopher S, Macdonald Peter S, Jabbour Andrew, Greenfield Jerry R
Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia.
Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, NSW, Australia.
JHLT Open. 2024 Apr 12;5:100088. doi: 10.1016/j.jhlto.2024.100088. eCollection 2024 Aug.
Sodium glucose cotransporter 2 inhibitors (SGLT2i) are an established treatment for heart failure and type 2 diabetes. Guidelines suggest withholding SGLT2i preoperatively due to the risk of ketoacidosis. Orthotopic heart transplantation (OHT) occurs without sufficient notice to cease SGLT2i treatment before surgery. In a retrospective analysis of 163 OHT recipients (40 exposed to SGLT2i, 123 not exposed), we show no increase in rates of mild, moderate, or severe acidosis postoperatively. No cases of ketoacidosis occurred, likely due to the fact that 97% of patients received insulin infusions postoperatively for transient postoperative hyperglycemia. Patients exposed to SGLT2i had shorter length of stay in the intensive care unit and improved adjusted survival overall. These findings support the safety of SGLT2i use up to the time of OHT with routine use of a postoperative insulin infusion.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）是治疗心力衰竭和2型糖尿病的一种既定疗法。指南建议术前停用SGLT2i，因为存在酮症酸中毒风险。原位心脏移植（OHT）在未提前足够时间通知以便在手术前停用SGLT2i治疗的情况下进行。在一项对163例OHT受者的回顾性分析中（40例使用SGLT2i，123例未使用），我们发现术后轻度、中度或重度酸中毒发生率并未增加。未发生酮症酸中毒病例，这可能是因为97%的患者术后因短暂性术后高血糖接受了胰岛素输注。使用SGLT2i的患者在重症监护病房的住院时间较短，总体调整后生存率有所提高。这些发现支持在OHT前使用SGLT2i直至手术时并常规使用术后胰岛素输注的安全性。
