Ischemia Coronary Artery Origin Clinical Trial
Official title:
High Thoracic Epidural Reduces Risks of Increased Left Ventricular Mass Index and Coronary Vascular Disease During Aortic Valve Replacement Alone or in Addition to Coronary Artery Bypass Graft Surgery
Increased left ventricular mass index (LVMI) results from aortic valve lesions as an adaptive mechanism to help limit systolic wall stress and preserve ejection fraction (EF). This study Aim to investigate the effects of sympathetic blockade by HTEA on systolic and diastolic LV function in patients undergoing aortic valve replacement (AVR) alone or in addition to coronary artery bypass graft (CABG). It Designs as A prospective randomized controlled comparative study in which eighty patients received either general anesthesia ( control group n=40) or with high thoracic epidural analgesia(HTEA group n=40). Each group subdivided to normal (LVM) (n=20)or increased(LVM) group(n=20), all submitted to (AVR) alone or in addition to (CABG).
Background: Increased left ventricular mass index (LVMI) results from aortic valve lesions as
an adaptive mechanism to help limit systolic wall stress and preserve ejection fraction (EF).
Aim: to investigate the effects of sympathetic blockade by HTEA on systolic and diastolic LV
function in patients undergoing aortic valve replacement (AVR) alone or in addition to
coronary artery bypass graft (CABG).
Design: A prospective randomized controlled comparative study. Methods: Eighty patients
received either general anesthesia ( control group n=40) or with high thoracic epidural
analgesia(HTEA group n=40). Each group subdivided to normal (LVM) (n=20)or increased(LVM)
group(n=20), all submitted to (AVR) alone or in addition to (CABG).Perioperative heart rate
(HR), mean arterial blood pressure (MAP), incidence of ischemic ECG, LV systolic and
diastolic function changes were measured till 48 h, postoperatively.
Patients were subjected to ambulatory Holter monitoring, Hemodynamic measures, intraoperative
transesophageal echocardiography (iTEE) and postoperative Trans Thoracic Echocardiography
(TTE) to assess myocardial ischemia and Left ventricular systolic/diastolic function.
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