title: Intraoperative use of several inotropes is associated with increased mid-term mortality in patients undergoing orthotopic heart transplantation.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  In patients undergoing OHT, mid-term survival was mostly related to D/R weight mismatch and intraoperative factors, mainly inotropic drugs and CPB duration.
authors.affiliation: Department of Anesthesiology, Hospital Italiano de Buenos Aires, Argentina. Electronic address: juancbian@gmail.com.
authors.forename: J C
authors.initials: JC
authors.lastname: Bianco
authors.affiliation: Department of Anesthesiology, Hospital Italiano de Buenos Aires, Argentina.
authors.forename: P I
authors.initials: PI
authors.lastname: Rossi
authors.affiliation: Department of Cardiology, Hospital Italiano de Buenos Aires, Argentina.
authors.forename: C A
authors.initials: CA
authors.lastname: Belziti
authors.affiliation: Department of Anesthesiology, Hospital Italiano de Buenos Aires, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: García Fornari
authors.affiliation: Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Argentina.
authors.forename: R G
authors.initials: RG
authors.lastname: Marenchino
mesh_terms: D000328:Adult; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000209:etiology; D016027:Heart Transplantation / Q000401:mortality*; D006439:Hemodynamics; D006801:Humans; D007432:Intraoperative Period; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000139:chemically induced; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate
chemical_list: D002316:Cardiotonic Agents