Open Mitral Cardiac Surgery
Conditions
Brief summary
Can pre-operative left stellate ganglion block offer myocardial protection in on-pump mitral valve replacement? A histopathological and clinical assessment.
Interventions
PROCEDUREsonar guided stellate ganglion injection
using high frequency probe, sonar guided stellate ganglion block with 8 ml saline 0.9%
PROCEDUREsonar guided stellate ganglion block
using high frequency probe, sonar guided stellate ganglion block with 8 ml bupivacaine 0.25%
Sponsors
Minia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
25 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Adult population of both sex, between 25-50 years, will undergo elective on pump mitral valve replacement
Exclusion criteria
* -Combined valve replacement ( mitral and aortic or mitral and tricuspid valves replacement). * Emergency valve replacement ( stuck valve, infective endocarditis). * Pre-operative cardiomyopathy (Ejection fraction less than 45%). * Recent myocardial infarction ( within 6 months) * Redo mitral valve replacement. * Pre-operative pacing, or cardioverter, any form arrhythmia ( tachy or brady). * Previous history of carotid endarterectomy or presence of carotid stent. * On thrombolytic therapy. * Severe chronic obstructive airway disease, * Patient refusal
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients with microscopic myocardial injury | intra-operative | Biopsy from left papillary muscle to investigate microscopic evidence of cellular injury ( cytoplasmic oedema, hemorrhage and necrosis). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intra-operative arrhythmia | intraoperatively | incidence of intraoperative atrial fibrillation |
| postoperative arrhythmia | first, second and third day after bypass | Incidence of post operative atrial or ventricular arrhythmia |
| Troponin I | before operation, immediately after ICU admission and 3 days post-operative | Serum troponin I to diagnose myocardial injury |
| Myocardial function | pre-operative, one week | Ejection fraction |
| weaning from mechanical ventilation | 24 hours post-operative | Time from ICU admission till successful extubation |
| Time of cardiopulmonary bypass | Intraoperative | — |
| Length of ICU stay | one week | — |
| Need for pacing | intraoperative and one week after | — |
Countries
Egypt
Outcome results
None listed