Thoracic Epidural Anesthesia Improves Early Outcome in Patients Undergoing Cardiac Surgery for Mitral Regurgitation: A Propensity-Matched Study

Objective: There are no large studies that investigate the effect of thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) in patients undergoing valvular surgery. The authors hypothesized that TEA might improve clinically relevant endpoints in patients with primary mitral regurgitation. Design: Propensity-matched study. Setting: Cardiac surgery. Participants: Patients scheduled for mitral valve repair or replacement were studied. Interventions: A propensity model was constructed to match 33 patients receiving TEA combined with GA with 33 patients receiving standard GA alone. Measurements and Main Results: Overall, the TEA group suffered fewer adverse events than the GA group: 10 (30%) v 23 (10%) with p = 0.002. In particular, the TEA group had a lower incidence of pulmonary events, 6 (18%) v 15 (45%) with p = 0.02, and of cardiac events, 8 (24%) v 16 (49%) with p = 0.04. Median (interquartile) time on mechanical ventilation was reduced in the TEA group, 11 (9-15) v 17 (12-36) with p = 0.007. Conclusions: This propensity-matched study suggested that TEA might be advantageous in patients undergoing surgery for mitral regurgitation. (C) 2013 Elsevier Inc. All rights reserved.