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

Autor: Ahmed Said Elgebaly, Yaser Elbarbary, Ayman Sallam, Sameh M Fathy
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Heart Ventricles
Ischemia
Myocardial Ischemia
030204 cardiovascular system & hematology
Ventricular Function
Left
lcsh:RD78.3-87.3
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Aortic valve replacement
030202 anesthesiology
coronary artery bypass graft
Internal medicine
Heart rate
medicine
Humans
Prospective Studies
Coronary Artery Bypass
Intraoperative Complications
Aged
Heart Valve Prosthesis Implantation
left ventricular mass index
business.industry
General Medicine
Perioperative
Organ Size
medicine.disease
high thoracic epidural
Analgesia
Epidural
Anesthesiology and Pain Medicine
medicine.anatomical_structure
Blood pressure
Ventricle
lcsh:Anesthesiology
lcsh:RC666-701
Echocardiography
Aortic Valve
Cardiology
Female
Original Article
Cardiology and Cardiovascular Medicine
business
Perfusion
Artery
Zdroj: Annals of Cardiac Anaesthesia
Annals of Cardiac Anaesthesia, Vol 23, Iss 2, Pp 154-160 (2020)
ISSN: 0974-5181
Popis: 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.
Databáze: OpenAIRE
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