High thoracic epidural decreases perioperative myocardial ischemia and improves left ventricle function in aortic valve replacement alone or in addition to cabg surgery even with increased left ventricle mass index

Abstract

Introduction: High thoracic epidural (HTE) may reduce perioperative tachyarrhythmias, respiratory complications and myocardial ischemia (MI) and it may increase coronary perfusion and myocardial oxygen balance through sympatholysis and pain control. The aim of this study is to investigate the benefit of HTE in patients undergoing aortic valve replacement (AVR) alone or in addition to coronary artery bypass graft (CABG). Methods: This prospective randomized controlled study was conducted on 80 patients (40 with increased left ventricular mass index (LVMI) and 40 with normal LVMI) who were equally randomised ( n = 40) to receive either GA with HTE (HTE group) or GA alone (GA group). Heart rate (HR), mean arterial blood pressure (MAP) and the incidence of ischemic ECG changes were recorded. LV functions (preoperative and postoperative by transthoracic echocardiography and intraoperative by transoesophageal echocardiography) were measured preoperative, intraoperative and till 48 H postoperative. Results: There was no significant difference in the baseline values of all measurements. HR and MAP were lower, and LV functions were improved in HTE group intraoperatively and postoperatively. Ischemic ECG changes were significantly lower in HTE group; with 42.9% intraoperative risk reduction (95% CI: 0.195-0.943) and 46.6% postoperative risk reduction (95% CI 0.227-0.952) as compared to GA group. The risk of ischemia was significantly higher in patients with increased LVMI in GA group (2.25 times compared to normal LVMI patients with 95% CI: 1.195-4.236), but it wasn't increased in HTE group. LV functions were significantly improved from the induction to 48 H postoperative in HTE group as compared to GA group. Conclusion: HTE reduced the incidence of MI and improved the LV function, even with increased LVM, in patients undergoing AVR alone or in addition to CABG.

Comparison of traditional and upper thoracic epidural analgesia after off‐pump coronary artery bypass graft surgery: A Quasi‐experimental study

“…22 However, the use of TEA decreased the incidence of myocardial infarction (MI), and it enhanced left ventricle (LV) function in patients undergoing aortic valve replacement alone or in combination with CABG, even when the left ventricular mass was increased. 23 …”

“…Cardiac surgery requires anticoagulants, and it is not widely accepted due to concerns about neuraxial hematoma following anticoagulants. 1 , 14 , 21 , 22 , 23 , 24 , 25 , 26 A few trials have demonstrated the safety of regional anesthetic and analgesic techniques in the context of possible anticoagulation during cardiac surgery. 1 , 19 Regional blocks have enormous potential to be integrated into hospitals' acute pain management paradigms following cardiac surgery, given their initial success in decreasing pain scores and reducing opiate usage.…”

“…Thoracic epidural anesthesia should be preferred for thoracic surgeries due to its longer duration and advantage of prolonged postoperative pain management 22 . However, the use of TEA decreased the incidence of myocardial infarction (MI), and it enhanced left ventricle (LV) function in patients undergoing aortic valve replacement alone or in combination with CABG, even when the left ventricular mass was increased 23 …”

“…22 However, the use of TEA decreased the incidence of myocardial infarction (MI), and it enhanced left ventricle (LV) function in patients undergoing aortic valve replacement alone or in combination with CABG, even when the left ventricular mass was increased. 23 Cardiac surgery requires anticoagulants, and it is widely accepted due to concerns about neuraxial hematoma following anticoagulants. 14,[21][22][23][24][25][26] A few trials have demonstrated the safety of regional anesthetic and analgesic techniques in the context of possible anticoagulation during cardiac surgery.…”

The effect of thoracic epidural analgesia on short-term outcome and mortality in geriatric patients undergoing open heart surgery

“…[15,16] TEA has been reported to improve ventricular function, minimize the risk of myocardial infarction, and reduce the development of rhythm disorders. [17,18] The positive effects of TEA on postoperative morbidity and mortality have been reported in several studies in the literature. However, the number of studies investigating the effects of TEA on the geriatric patient population undergoing open heart surgery is few.…”