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Intraoperative use of several inotropes is associated with increased mid-term mortality in patients undergoing
J C Bianco1, P I Rossi1, C A Belziti2
1Department of Anesthesiology, Hospital Italiano de Buenos Aires, Argentina.
Insights
Mid-term mortality after orthotopic heart transplantation (OHT) is linked to donor/recipient weight mismatch and intraoperative factors like inotropic drug use and cardiopulmonary bypass duration. Optimizing these can improve patient survival post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Outcomes
Background:
- Orthotopic heart transplantation (OHT) is a life-saving procedure for end-stage heart failure.
- Inotropic agents are crucial for supporting donor heart function post-transplant.
- Excessive inotropic agent use can lead to cardiac toxicity, arrhythmias, and myocyte damage.
Purpose of the Study:
- To identify perioperative predictors of mid-term mortality following OHT.
- To analyze factors influencing survival rates in heart transplant recipients.
Main Methods:
- Retrospective analysis of adult OHT patients from 2009-2013.
- Inclusion of donor/recipient demographics, hemodynamic profiles, and perioperative data.
- Primary endpoint: mid-term survival assessment.
Main Results:
- Overall survival was 80.6% during hospitalization and 70.1% at mid-term follow-up.
- Independent risk factors for mortality included intraoperative inotropic drug use (>2), cardiopulmonary bypass duration, and donor/recipient weight ratio mismatch.
- Univariate analysis identified older age, lower height/BSA, D/R mismatch, prior cardiac surgery, longer CPB time, lower postoperative LVEF, sepsis, and PGD as associated with mortality.
Conclusions:
- Mid-term survival after OHT is significantly influenced by donor/recipient weight mismatch.
- Intraoperative factors, specifically the number of inotropic drugs and cardiopulmonary bypass duration, are key predictors of mortality.
- Addressing these perioperative factors may enhance long-term outcomes for heart transplant recipients.
Introduction:
Orthotopic heart transplantation (OHT) is the gold standard treatment for patients with end-stage heart failure. Inotropic agents are the hemodynamic mainstay in the treatment of implanted donor hearts. However, their infusion, particularly in excess, can have unintended consequences that lead to cardiac toxicity and can originate malignant arrhythmias, myocardial necrosis, and myocyte apoptosis.
Objective:
The aim of the study was to determine the perioperative predictors of mid-term mortality after OHT.
Methods:
We retrospectively studied all consecutive adult patients who underwent OHT between January 2009 and July 2013 at a tertiary care university hospital and followed them up until July 2013. Donor and recipient demographic data, hemodynamic profile, and perioperative data were analyzed. The primary endpoint was mid-term survival.
Results:
The overall survival rate was 80.6% during hospitalization time and 70.1% after 328 (interquartile range, 643) days of follow-up. The univariate analysis showed that patients who died were older, had lower height and body surface area, donor/recipient (D/R) mismatch, prior cardiac surgery, longer cardiopulmonary bypass (CPB) time, postoperative lower left ventricular ejection fraction, sepsis, and primary graft dysfunction. Using Cox survival analysis, the independent risk factors related to mid-term mortality were intraoperative use of more than 2 inotropic drugs (hazard ratio [HR], 3.887; 95% confidence interval [CI], 1.224-12.342; P = .021), CPB duration (HR, 1.008; 95% CI, 1.003-1.014; P = .002), and D/R weight ratio (HR, 1.027; 95% CI, 1.009-1.046; P = .003).
Conclusion:
In patients undergoing OHT, mid-term survival was mostly related to D/R weight mismatch and intraoperative factors, mainly inotropic drugs and CPB duration.
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