Assessment of the Impact of Dexmedetomidine on Myocardial Injury in TAVI Patients: A Retrospective Cohort Study Utilizing PSM-DID

Abstract

Yang Song,1,&ast; Jin Zhang,2,&ast; Huiping Xu,2 Chaoqun Gui,2 Hao Cheng,1 Yongquan Chen,1 Shaolin Wang2 1Department of Anaesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, People’s Republic of China; 2Department of Anaesthesiology, The Second People’s Hospital of Wuhu, Wuhu, 241001, People’s Republic of China&ast;These authors contributed equally to this studyCorrespondence: Yongquan Chen, Department of Anaesthesiology, The First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu City, Anhui Province, 241001, People’s Republic of China, Email [email protected] Shaolin Wang, Department of Anaesthesiology, The Second People’s Hospital of Wuhu, No. 6 Duchun Road, Wuhu City, Anhui Province, 241000, People’s Republic of China, Email [email protected]: Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure for treating severe aortic valve diseases but can lead to perioperative myocardial damage (PMD). Dexmedetomidine (DEX), an α 2-adrenergic receptor agonist, has shown potential to reduce myocardial injury in other cardiac procedures. This effect is attributed to its anti-inflammatory properties, which help reduce the inflammatory response associated with myocardial damage, and its antioxidant properties, which combat oxidative stress that contributes to cell injury. But its effectiveness during TAVI remains unclear.Objective: To assess the impact of DEX on myocardial injury in patients undergoing TAVI under general anesthesia.Methods: A retrospective cohort study of 159 patients (after exclusions) who underwent TAVI from January 2022 to August 2024. Patients were divided into DEX and control groups. Primary outcomes were peak levels of cardiac troponin I and CK-MB within 48 hours postoperatively. Secondary outcomes included IL-6, PCT, and NT-proBNP levels. Propensity score matching (PSM) and Differences-in-Differences (DID) method were used for analysis.Results: After PSM, the DEX group exhibited significantly lower peak values of troponin I (P < 0.001) and CK-MB (P < 0.001) compared to the control group, indicating reduced myocardial injury. No significant differences were observed in IL-6, PCT, and NT-proBNP levels between the groups. The DID analysis suggested a negative correlation between DEX use and major adverse postoperative events, highlighting DEX as a potential protective factor.Conclusion: Dexmedetomidine administration during TAVI was associated with reduced levels of myocardial injury markers, indicating a potential cardioprotective role. By reducing myocardial injury, DEX may contribute to improved perioperative outcomes, including a decreased risk of major adverse postoperative events. These results highlight the potential clinical utility of DEX in the perioperative management of TAVI patients, suggesting that its inclusion in anesthetic protocols could enhance patient care and recovery.Keywords: dexmedetomidine, transcatheter aortic valve replacement, myocardial ischemia, inflammation, propensity score

Keywords

• Dexmedetomidine
• Transcatheter Aortic Valve Replacement
• Myocardial Ischemia
• Inflammation
• Propensity Score