Key result
High thoracic epidural combined with general anesthesia significantly improved left ventricular ejection fraction at 48 hours (59.4% vs 54.6%) and reduced postoperative myocardial ischemia by 46.6% compared to general anesthesia alone in patients undergoing aortic valve replacement.
Why the study?
High thoracic epidural may reduce perioperative complications and myocardial ischemia, motivating an investigation of its benefit in patients undergoing AVR alone or in addition to CABG.
Does high thoracic epidural added to general anesthesia reduce perioperative myocardial ischemia and improve LV function in patients undergoing AVR with or without CABG?
RCT (n=80)
Sealed envelope method
No
Does high thoracic epidural added to general anesthesia reduce perioperative myocardial ischemia and improve LV function in patients undergoing AVR with or without CABG?
High thoracic epidural combined with general anesthesia reduces perioperative myocardial ischemia and improves LV function in patients undergoing AVR with or without CABG, regardless of baseline LV mass index.
Answers are grounded in this paper and cite their sources.
Supports adding high thoracic epidural to general anesthesia for cardioprotection during aortic valve.
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.
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Elgebaly et al. (2020) conducted an RCT in Aortic valve replacement (AVR) alone or in addition to CABG (n=80). High thoracic epidural (HTE) with general anaesthesia vs. General anaesthesia (GA) alone was evaluated on Left ventricular ejection fraction (LVEF) at 48 hours postoperative (p=<0.001). High thoracic epidural combined with general anesthesia significantly improved left ventricular ejection fraction at 48 hours (59.4% vs 54.6%) and reduced postoperative myocardial ischemia by 46.6% compared to general anesthesia alone in patients undergoing aortic valve replacement.
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