Reversible Cardiac Sympathectomy by High Thoracic Epidural Anesthesia Improves Regional Left Ventricular Function in Patients Undergoing Coronary Artery Bypass Grafting

Berendes, Elmar; Schmidt, Christoph; Aken, Hugo Van; Hartlage, Maike Grosse; Wirtz, Stefan; Reinecke, Holger; Rothenburger, Markus; Scheld, Hans H.; Schlüter, B.; Brodner, G.; Walter, Michael

doi:10.1001/archsurg.138.12.1283

Cited by 80 publications

(35 citation statements)

References 35 publications

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“…The use of high thoracic epidural anesthesia exerts salutary effects on the coronary circulation as well as myocardial and pulmonary function, attenuates the stress response, and provides prolonged postoperative analgesia (24,25,35). In the United States, however, concerns about the potential for neuraxial bleeding (particularly in the setting of heparinization, platelet inhibitors, and CPBinduced thrombocytopenia), local anesthetic toxicity, and logistical issues related to the timing of epidural catheter insertion and management have resulted in limited use of these techniques (22).…”

Section: Class Imentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Hillis

Smith

Anderson³

et al. 2011

Journal of the American College of Cardiology

662

161

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Section: Class Imentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Hillis

Smith

Anderson³

et al. 2011

Journal of the American College of Cardiology

662

161

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“…Two studies reported on mid-term (!12 months) results [16,17], eight on short-term ( 30 days) results [18][19][20][21][22][23][24][25] and seven on both [13,[26][27][28][29][30][31], with a total of 237 mid-term deaths by any cause in 5119 patients and 296 short-term deaths by any cause in 9703 patients. Six of the mid-term studies [17,[26][27][28]30,31] described the completeness of their follow-up that ranged from 84% to 100%.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Two studies [16,20] only showed adjusted associations of troponin with all-cause mortality and crude data could not be obtained. Therefore, these studies could not be used for statistical pooling and were only reported descriptively ( Table 2).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…We considered the description of the troponin measurement (index test) sufficient for replication in 15 [13,[16][17][18][19][20][21][22]24,[26][27][28]30]. Sixteen [13,[16][17][18][19][20][21][22][23][24][25][26][28][29][30][31]] of 17 studies clearly described their criteria for selecting patients. Of the 12 studies that did not address in-hospital all-cause mortality, only eight described the follow-up methods (execution of the reference standard) used [13,17,26,[28][29][30].…”

Section: Quality Assessmentmentioning

confidence: 99%

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The prognostic value of troponin release after adult cardiac surgery — a meta-analysis

Buse

Koller

Grapow

et al. 2009

European Journal of Cardio-Thoracic Surgery

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To assess the accuracy of increased troponin (Tn) concentrations for the prediction of mid-term (> or = 12 months) mortality after coronary artery bypass graft (CABG) and valve surgery, we performed a systematic review identifying all studies reporting on the association between postoperative troponin release and mortality after cardiac surgery. Studies were identified through 30 April 2008 by electronic searches of the MEDLINE, EMBASE and BIOSIS databases. Two reviewers independently selected studies, assessed methodological quality and extracted the data. We primarily considered mid-term (> or = 12 months) and secondarily short-term (< or = 30 days) all-cause mortality. A bivariate random-effects model was used to study determinants and to pool measures of prognostic accuracy of Tn. Seventeen studies fulfilled the inclusion criteria with a total of 237 mid-term deaths in 5189 patients and 296 short-term deaths in 9703 patients. The diagnostic odds ratio of increased Tn concentrations was 5.46 (95% confidence interval (CI) 2.0-14.6) for mid-term mortality and 6.57 (95% CI 4.3-10.1) for short-term mortality after adult cardiac surgery. Alternatively expressed, for troponin elevation, the sensitivity was 0.45 (0.26-0.67) and the specificity 0.87 (0.73-0.90) to predict mid-term mortality. The sensitivity was 0.59 (0.48-0.69) and the specificity 0.82 (0.72-0.89) for short-term mortality. Between-study variability was high. In conclusion, this meta-analysis provides evidence for an association between postoperative Tn release with mid- and short-term all-cause mortality after adult cardiac surgery. However, differences in populations, timing of Tn testing, Tn subunit and Tn assays make definitive conclusions about effect size and cut-off values difficult.

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“…It has been proven that inhibition of sympathetic excitation in HF blunts myocardial fibrosis [8,9,10,11]. Thoracic epidural anaesthesia inhibits thoracic sympathetic activity and provides cardiac protection during cardiac surgery [12,13]. Low concentrations of local anaesthetics introduced via the high thoracic epidural cavity induce high thoracic sympathetic block (HTSB) without effecting sensory and motor nerves.…”

Section: Introductionmentioning

confidence: 99%

Effect of High Thoracic Sympathetic Nerve Block on Serum Collagen Biomarkers in Patients with Chronic Heart Failure

Sun

Liu²,

Qu³

2016

Cardiology

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Objectives: The impact of high thoracic sympathetic block (HTSB) on myocardial fibrosis in chronic heart failure (HF) is unclear. Myocardial collagen synthesis can be assessed by measuring circulating biomarkers. Weobserved the effect of HTSB on serum collagen biomarkers in HF. Methods: Forty-four patients were randomized to a control and a HTSB group. They received routine medications. Repeated epidural injections were given to the HTSB group for 4 weeks. Echocardiography and measurements of serum carboxy-terminal propeptide of procollagen type I (PICP) and amino-terminal propeptide of procollagen type III (PIIINP) were performed at baseline and 4 weeks later. Results: There were significant reductions in left atrial diameter, left ventricular (LV) diameter and volume, LV weight index (LVWI) and serum PICP and PIIINP levels in the HTSB group (p < 0.05). The changes in LV end-systolic volume and ejection fraction (LVEF) were greater in the HTSB group than in the control group (p < 0.05). In the HTSB group, the decreases in PICP and PIIINP were correlated with the decrease in LVWI (PICP: r = 0.695, p = 0.000; PIIINP: r = 0.642, p = 0.001), and the decrease in PICP was negatively associated with the rise in LVEF (r = -0.813, p = 0.000). Conclusion: HTSB reduces myocardial fibrosis in HF, which may accompany the improvement of LV hypertrophy anddysfunction.

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Reversible Cardiac Sympathectomy by High Thoracic Epidural Anesthesia Improves Regional Left Ventricular Function in Patients Undergoing Coronary Artery Bypass Grafting

Cited by 80 publications

References 35 publications

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

The prognostic value of troponin release after adult cardiac surgery — a meta-analysis

Effect of High Thoracic Sympathetic Nerve Block on Serum Collagen Biomarkers in Patients with Chronic Heart Failure

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