Duration of preoperative amiodarone treatment may be associated with postoperative hospital mortality in patients undergoing heart transplantation

Objective: To assess the effect of preoperative amiodarone treatment on pat ient mortality after heart transplantation. Design: Retrospective study. Setting: Single-institution university hospital. Participants: One hundred six consecutive patients with heart transplants. Interventions: None. Measurements and Main Results: Patients were grouped according to duration of preoperative amiodarone treatment, and posttransplant mortality before h ospital discharge was compared with patients not treated with amiodarone, T he authors collected cardiovascular data in the preoperative and postoperat ive periods. There was a significant increase in posttransplant mortality b efore hospital discharge in patients treated with amiodarone for more than 4 weeks in the preoperative period (p < 0.05), Patients treated with amioda rone had significantly lower (p < 0.05) heart rates (mean heart rate, 103 /- 19 beats/min) in the early postoperative period than patients not treate d with amiodarone (mean heart rate, 111 +/- 15 beats/min), but there was no relationship with mortality (p = not significant). Patients who died had a significantly lower (p < 0.05) postoperative cardiac index (2.2 +/- 0.7 to 2.5 +/- 0.7) in the first 24 hours after cardiopulmonary bypass compared w ith patients who survived to hospital discharge (3.0 +/- 0.7 to 3.1 +/- 0.9 ), but there was no relationship to amiodarone treatment (p = not significa nt). Conclusion: Preoperative amiodarone treatment for more than 4 weeks may be associated with a significant increase in postoperative mortality in patien ts undergoing heart transplantation. Therefore, the indications for amiodar one must be carefully considered and, if needed, the maintenance dose shoul d be kept to a minimum. Copyright (C) 1999 by W.B. Saunders Company.