Griffin Calme, PharmD
PGY2 Critical Care Pharmacy Resident
Saint Joseph Mercy Oakland
Pontiac, MI
Disclosure information not submitted.
Richard Valone, Jr., PharmD, BCPS
Clinical Pharmacy Specialist, Cardiology
St. Joseph Mercy Oakland
Pontiac, Michigan, United States
Disclosure information not submitted.
Kaitlyn DeHoff, PharmD, BCCCP
Clinical Pharmacy Specialist - Medical/Surgical Services
Saint Joseph Mercy Oakland, United States
Disclosure information not submitted.
Title: Effect of Intraoperative Dexmedetomidine on Outcomes for Transcatheter Aortic Valve Replacement 
Purpose: Dexmedetomidine use in cardiac surgery is associated with shorter length of stay (LOS) and lower rates of post-operative atrial arrhythmias, delirium, stroke, and acute kidney injury (AKI). Dexmedetomidine's effects in patients undergoing transcatheter aortic valve replacement (TAVR) remains unknown. The purpose of this study was to compare outcomes in patients who underwent TAVR and received dexmedetomidine intraoperatively to those who did not receive dexmedetomidine.
Methods: This single-center, retrospective cohort study evaluated 165 adults who underwent TAVR from November 2017 to November 2020. Patients who received clonidine within 48 hours were excluded. The primary outcome was post-operative LOS. Secondary outcomes included intensive care unit (ICU) LOS, new atrial arrhythmia, AKI, delirium, and discharge disposition. Safety outcomes included 30-day mortality, stroke, myocardial infarction, cardiac arrest, venous thromboembolism, surgical site infection, clinically relevant hypotension, and permanent pacemaker placement.
Results: Of 165 patients evaluated, 163 were included for analysis. Of those included, 119 (73%) received dexmedetomidine. Post-operative LOS was shorter in patients who received dexmedetomidine (median 3.06 [IQR 2.15-4.96] vs 3.53 [2.25-6.11] days, p=0.041). No differences were found in secondary or safety outcomes. Rate of permanent pacemaker implantation was higher in the dexmedetomidine group, but not statistically different (RR 2.06, 95% CI 0.936-4.54, p=0.051). Patients who did not receive dexmedetomidine were more likely to have had general anesthesia (GA), transcarotid access, vascular complications, and valve-in-valve procedures. Monitored anesthesia care was associated with a shorter length of stay compared to GA (median 3.04 [2.16-4.76] vs 4.09 [2.21-6.13] days, p=0.019).
Conclusion: Intraoperative use of dexmedetomidine in patients undergoing TAVR was associated with shorter length of stay, which may be partly attributed to the use of monitored anesthesia care. Additional studies with a larger sample size are needed to assess effect of dexmedetomidine on other patient outcomes, such as post-operative atrial arrhythmias.