Torregroza Carolin, Endreß Carla L, M'Pembele René, Roth Sebastian, Stroda Alexandra, Aubin Hug, Lichtenberg Artur, Buse Giovanna Lurati, Huhn Ragnar, Boeken Udo
Department of Anesthesiology, Kerckhoff Heart and Lung Centre, Bad Nauheim, Germany.
Department of Anesthesiology and Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
BJA Open. 2025 Mar 14;14:100389. doi: 10.1016/j.bjao.2025.100389. eCollection 2025 Jun.
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.
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.
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% no dexmedetomidine 15.5%, =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, =0.03).
Perioperative dexmedetomidine treatment appears to be safe regarding 1-yr mortality in patients undergoing orthotopic heart transplantation.
心脏移植仍然是终末期心力衰竭的金标准治疗方法。心脏移植的预后不断改善，10年生存率为53%。右美托咪定常用于心脏病患者的镇静。最近，由于其在SPICE 3试验中与死亡率增加相关，其临床应用受到限制。围手术期右美托咪定治疗对心脏移植患者的影响尚未得到研究。因此，本研究调查了右美托咪定治疗对心脏移植患者1年死亡率的影响。
这项回顾性队列研究纳入了2011年至2021年在杜塞尔多夫大学医院接受心脏移植的患者。主要暴露因素是围手术期右美托咪定治疗。主要终点是术后1年死亡率。进行了Kaplan-Meier分析和多变量cox回归，并对心脏移植后死亡率预测风险指数（IMPACT）和红细胞压积进行了调整。
共筛选出267例患者。为避免潜在的选择偏倚，排除了需要术后使用体外生命支持系统治疗的患者，最终纳入分析的患者有169例。在这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%（右美托咪定组为4.9%，未使用右美托咪定组为15.5%，P=0.025）。在对IMPACT评分和红细胞压积进行调整后，右美托咪定治疗与心脏移植后较低的1年死亡率独立相关（风险比：0.25，95%置信区间0.07-0.93，P=0.03）。
对于接受原位心脏移植的患者，围手术期右美托咪定治疗在1年死亡率方面似乎是安全的。
