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• W4387477475 abstract "Introduction Prognosis of orthotopic heart transplantation (HT) has continuously improved, with a 10-year survival of 53%.¹ One major risk factor for mortality after HT remains warm and cold ischemia time, partly due to consequences of Ischemia and Reperfusion (I/R) injury. Further, acute kidney injury (AKI) and renal failure is a common complication after HT, independent of a pre-existing kidney injury.² Patients often require early or late dialysis, which is accompanied with an increased risk of mortality. The alpha-2-agonist Dexmedetomidine (Dex) is commonly used as a sedative in cardiac patients and for prevention of postoperative delirium. Experimental studies have shown cardioprotective properties of Dex after I/R-Injury. Moreover, Dex also exerts a protective effect on renal function, especially considering AKI after cardiac surgery.³ The impact of perioperative Dex treatment on patients undergoing HT has not been examined, yet. Therefore, this study investigated the influence of Dex treatment on myocardial and renal damage as well as delirium in patients undergoing HT. Methods The retrospective cohort study was approved by the ethics committee of the Heinrich-Heine University Duesseldorf and included adult patients who received an orthotopic heart transplantation at the University Hospital Duesseldorf, Germany between 2011 and 2021. The main exposure was intraoperative Dexmedetomidine treatment during HT surgery. The primary endpoint was myocardial injury measured by high sensitivity troponin T (hsTnT) at 24h postoperatively. Secondary endpoints were acute kidney injury (AKI) defined by KDIGO classification and occurrence of postoperative delirium up to 72h after HT. Univariate linear and logistic regression as well as multivariate logistic regression with adjustment for risk factors for AKI after HT were performed Results A total of 246 patients were screened and 161 were included into analysis. Patients with missing data regarding primary and secondary endpoints as well as patients who were treated with Dex only on the ICU but not during HT were excluded from analysis. Out of 161 patients, 37 received intraoperative Dex treatment and 124 were not treated with Dex. Univariate linear regression demonstrated no association between Dex and myocardial injury (p = 0.523), regression coefficient of -592 (95%CI -2419 to 1235). Further no association was detected for Dex and occurrence of postoperative delirium in univariate logistic regression (p = 0.70) with an odds ratio of 1.21 (95%CI 0.47 to 3.15). Univariate logistic regression of Dex and AKI showed a statistical association (p = 0.015) with an odds ratio of 0.40 (95%CI 0.19 to 0.84). However, after adjustment for known risk factors for AKI after HT, multivariate logistic regression demonstrated no independent association between Dex treatment and occurrence of AKI (p = 0.35), with an odds ratio of 0.65 (95%CI 0.26 to 1.61). Regarding 1-year mortality, no differences were detected between both groups. Discussion The results of this retrospective study show no beneficial effect of Dexmedetomidine treatment on myocardial injury, AKI and postoperative delirium in patients undergoing orthotopic heart transplantation in this cohort." @default.
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• W4387477475 date "2023-10-01" @default.
• W4387477475 modified "2023-10-16" @default.
• W4387477475 title "Impact of dexmedetomidine treatment in patients undergoing orthotopic heart transplantation – A retrospective study" @default.
• W4387477475 doi "https://doi.org/10.1053/j.jvca.2023.08.095" @default.
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