Preoperative Amiodarone and Primary Graft Dysfunction in Heart Transplantation

Area of Science:

• Cardiology
• Transplant Surgery
• Pharmacology

Background:

• The impact of preoperative amiodarone on outcomes following orthotopic heart transplant (OHT) is debated.
• Amiodarone is frequently used for arrhythmia management in potential heart transplant recipients.

Purpose of the Study:

• To investigate the association between cumulative preoperative amiodarone exposure and severe primary graft dysfunction (PGD) after OHT.
• To evaluate secondary outcomes including graft failure, mortality, and postoperative complications.

Main Methods:

• Retrospective review of adult OHT recipients from August 2012 to June 2018.
• Comparison of severe PGD incidence between patients receiving amiodarone (at 3, 6, 12 months pre-OHT) and those not receiving it.
• Multivariate logistic regression analysis to assess the impact of amiodarone on PGD and other outcomes.

Main Results:

• A trend towards increased severe PGD was observed in patients on preoperative amiodarone (12.5% vs 6.8%).
• Cumulative amiodarone use significantly increased the odds of severe PGD at 3 and 6 months pre-OHT (OR 1.03 and 1.02, respectively).
• Patients on amiodarone had higher rates of postoperative bradycardia (13.4% vs 4.5%) and required permanent pacemaker implantation more frequently.

Conclusions:

• Preoperative amiodarone use is associated with a concerning trend of increased severe PGD after OHT.
• Increasing cumulative amiodarone dose prior to OHT significantly elevates the risk of severe PGD.
• Amiodarone therapy necessitates closer monitoring for bradycardia and potential pacemaker implantation post-OHT.