Song Yang, Zhang Jin, Xu Huiping, Gui Chaoqun, Cheng Hao, Chen Yongquan, Wang Shaolin
Department of Anaesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China.
Department of Anaesthesiology, The Second People's Hospital of Wuhu, Wuhu, 241001, People's Republic of China.
Ther Clin Risk Manag. 2025 May 1;21:583-592. doi: 10.2147/TCRM.S507439. eCollection 2025.
Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure for treating severe aortic valve diseases but can lead to perioperative myocardial damage (PMD). Dexmedetomidine (DEX), an α2-adrenergic receptor agonist, has shown potential to reduce myocardial injury in other cardiac procedures. This effect is attributed to its anti-inflammatory properties, which help reduce the inflammatory response associated with myocardial damage, and its antioxidant properties, which combat oxidative stress that contributes to cell injury. But its effectiveness during TAVI remains unclear.
To assess the impact of DEX on myocardial injury in patients undergoing TAVI under general anesthesia.
A retrospective cohort study of 159 patients (after exclusions) who underwent TAVI from January 2022 to August 2024. Patients were divided into DEX and control groups. Primary outcomes were peak levels of cardiac troponin I and CK-MB within 48 hours postoperatively. Secondary outcomes included IL-6, PCT, and NT-proBNP levels. Propensity score matching (PSM) and Differences-in-Differences (DID) method were used for analysis.
After PSM, the DEX group exhibited significantly lower peak values of troponin I (P < 0.001) and CK-MB (P < 0.001) compared to the control group, indicating reduced myocardial injury. No significant differences were observed in IL-6, PCT, and NT-proBNP levels between the groups. The DID analysis suggested a negative correlation between DEX use and major adverse postoperative events, highlighting DEX as a potential protective factor.
Dexmedetomidine administration during TAVI was associated with reduced levels of myocardial injury markers, indicating a potential cardioprotective role. By reducing myocardial injury, DEX may contribute to improved perioperative outcomes, including a decreased risk of major adverse postoperative events. These results highlight the potential clinical utility of DEX in the perioperative management of TAVI patients, suggesting that its inclusion in anesthetic protocols could enhance patient care and recovery.
经导管主动脉瓣植入术（TAVI）是一种用于治疗严重主动脉瓣疾病的微创手术，但可导致围手术期心肌损伤（PMD）。右美托咪定（DEX）是一种α2肾上腺素能受体激动剂，在其他心脏手术中已显示出减轻心肌损伤的潜力。这种作用归因于其抗炎特性，有助于减少与心肌损伤相关的炎症反应，以及其抗氧化特性，可对抗导致细胞损伤的氧化应激。但其在TAVI期间的有效性仍不明确。
评估DEX对全身麻醉下接受TAVI患者心肌损伤的影响。
对2022年1月至2024年8月接受TAVI的159例患者（排除后）进行回顾性队列研究。患者分为DEX组和对照组。主要结局是术后48小时内心肌肌钙蛋白I和肌酸激酶同工酶（CK-MB）的峰值水平。次要结局包括白细胞介素-6（IL-6）、降钙素原（PCT）和N末端脑钠肽前体（NT-proBNP）水平。采用倾向评分匹配（PSM）和差异-in-差异（DID）方法进行分析。
PSM后，DEX组的肌钙蛋白I峰值（P < 0.001）和CK-MB峰值（P < 0.001）显著低于对照组，表明心肌损伤减轻。两组间IL-6、PCT和NT-proBNP水平无显著差异。DID分析表明DEX的使用与术后主要不良事件呈负相关，突出了DEX作为潜在保护因素的作用。
TAVI期间给予右美托咪定与心肌损伤标志物水平降低相关，表明其具有潜在的心脏保护作用。通过减少心肌损伤，DEX可能有助于改善围手术期结局，包括降低术后主要不良事件的风险。这些结果突出了DEX在TAVI患者围手术期管理中的潜在临床应用价值，表明将其纳入麻醉方案可提高患者护理和恢复水平。
