Minimally Invasive Aortic Valve Replacement under Thoracic Epidural Anesthesia in a Conscious Patient: Case Report


  • Tomislav Klokocovnik
  • Jiri Hollan
  • Maja Sostaric
  • Tatjana Pintar
  • Tomislav Mirkovic



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.


Tuman KJ, McCarthy RJ, March RJ, et al. 1991. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 73:696-704.nArom KV, Flavin TF, Emery RW, et al. 2000. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg 69:704-10.nBenetti FJ. 1985. Direct coronary artery with saphenous vein bypass without either cardiopulmonary bypass or cardiac arrest. J Cardiovasc Surg 26:217-22.nDiegeler A, Martin M, Falk V, et al. 1999. Coronary bypass grafting without cardiopulmonary bypass: technical considerations, clinical results and follow-up. J Thorac Cardiovasc Surg 47:14-8.nKirno K, Friberg P, Grzegorczyk A, et al. 1994. Thoracic epidural anesthesia during coronary artery bypass surgery: effects on cardiac sympathetic activity, myocardial blood flow and metabolism, and central hemodynamics. Anesth Analg 79:1075-81.nLiem TH, Williams JP, Hensens AG, Singh SK. 1998. Minimally invasive direct coronary artery bypass procedure using a high thoracic epidural plus general anesthetic technique. J Cardiothorac Vasc Anesth 12:668-72.nMeisner A, Rolf N, Van Aken H. 1997. Thoracic epidural anesthesia and the patient with heart disease: benefits, risks and controversies. Anesth Analg 85:517-28.n



How to Cite

Klokocovnik, T., Hollan, J., Sostaric, M., Pintar, T., & Mirkovic, T. (2005). Minimally Invasive Aortic Valve Replacement under Thoracic Epidural Anesthesia in a Conscious Patient: Case Report. The Heart Surgery Forum, 7(3), E196-E197.




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