title: Thoracic epidural anesthesia improves early outcome in patients undergoing cardiac surgery for mitral regurgitation: a propensity-matched study.
abstract: 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.
  
  
  METHODS
  Propensity-matched study.
  
  
  METHODS
  Cardiac surgery.
  
  
  METHODS
  Patients scheduled for mitral valve repair or replacement were studied.
  
  
  METHODS
  A propensity model was constructed to match 33 patients receiving TEA combined with GA with 33 patients receiving standard GA alone.
  
  
  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.
authors.affiliation: Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Monaco
authors.forename: Camilla
authors.initials: C
authors.lastname: Biselli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Monica
authors.initials: M
authors.lastname: De Luca
authors.forename: Rosalba
authors.initials: R
authors.lastname: Lembo
authors.forename: Remo Daniel
authors.initials: RD
authors.lastname: Covello
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D003422:Critical Care; D023381:Endpoint Determination; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D015233:Models, Statistical; D016343:Monitoring, Intraoperative; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018401:Sample Size; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology