title: Minimally invasive aortic valve replacement under thoracic epidural anesthesia in a conscious patient: case report.
abstract: Cardiopulmonary bypass and full median sternotomy have been recognized as major morbidity factors in cardiac surgery. Additional morbidity factors are general anesthesia and endotracheal intubation. Over the past several years high-thoracic epidural anesthesia (hTEA) has emerged as a potentially beneficial supplement to general anesthesia in the care of patients undergoing cardiac surgery. We report a case of ministernotomy aortic valve replacement performed with hTEA. The procedure was not converted to general anesthesia or to a conventional operation and was performed without adverse incidents. The patient was discharged from the hospital on the 2nd postoperative day. There were no complications within 30 days after surgery. This case demonstrates that thoracic epidural anesthesia without endotracheal intubation used for aortic valve replacement performed through ministernotomy is feasible. Further experience is necessary to determine the safety of this method and the effect on outcome.
authors.affiliation: Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia. tomi.klokocovnik@siol.net
authors.forename: Tomislav
authors.initials: T
authors.lastname: Klokocovnik
authors.forename: Jiri
authors.initials: J
authors.lastname: Hollan
authors.forename: Maja
authors.initials: M
authors.lastname: Sostaric
authors.forename: Tatjana
authors.initials: T
authors.lastname: Pintar
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mirkovic
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D003243:Consciousness; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome