Awake Mitral Valve Repair Through Mini-thoracotomy With Thoracic Epidural Anesthesia
Yuta Koichi, Hiroto Kitahara, Naohiro Wakabayashi, Hayato Ise, Chiharu Tanaka, Sentaro Nakanishi, Natsuya Ishikawa, Hiroyuki Kamiya.
Asahikawa Medical University, Asahikawa, Japan.
Objective: General anesthesia with endo-tracheal intubation is sometimes contraindicated in specific patient group, who have allergy to anesthetic, or severe respiratory disability. In this report, we reviewed patients who underwent awake mitral valve repair through mini-thoracotomy with thoracic epidural anesthesia without endo-tracheal intubation. Methods: An epidural catheter was inserted in the T4 to T5 intervertebral space one day before surgery. A neural block from C3 to Th9 was confirmed with a cold test. In the operation room, an intravenous infusion of fentanyl and dexmedetomidine was used for light sedation without endo-tracheal intubation. A levobupivacaine was administered through the epidural catheter. Through the procedure, patients could make a communication with anesthesiologist. Mitral valve repair was performed same manner as that with general anesthesia. Cardiopulmonary bypass was established with the femoral artery and vein, and an additional cannula was inserted through the right jugular vein, if necessary. Right mini-thoracotomy was made in the 4th intercostal space. Annuloplasty ring was used in mitral valve repair. Results: Two patients underwent awake mitral valve repair through mini-thoracotomy with thoracic epidural anesthesia. No anesthesia related complication occurred. The first case was a 49-year-old man who had allergy to propofol and remifentanil. Awake mitral valve repair with resection and suture technique was performed. He was discharged at postoperative day 7 without any complications. The second case was 81-year-old man with delirium and respiratory disability. Awake mitral valve repair with folding plasty technique and tricuspid valve repair were performed. He was discharged at postoperative day 8 without complications. Conclusions: Awake minimally invasive mitral valve repair through mini-thoracotomy with thoracic epidural anesthesia was safely performed in our institution. The procedure would be an alternative minimally invasive treatment option for patients who need to avoid general anesthesia.
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