Measurement of cardiac biomarkers in open lobectomies: comparison of combined thoracic epidural anesthesia with general anesthesia to general anesthesia alone

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34TH EACTA ANNUAL CONGRESS ABSTRACTS / Journal of Cardiothoracic and Vascular Anesthesia 33 (2019) S140 S168

centers. The effect of case volume on cumulative all-cause mortality was also assessed. Results: A total of 6041 cases were performed in 86 centers. One-year mortality was 10.1% (175/1728), 8.7% (93/1067), and 4.7% (153/3246) in low-, medium-, and high-volume centers, respectively. Low- and medium-volume centers showed increased risk of 1-year mortality compared to high-volume centers (OR [95% CI]; 2.80 [2.15 3.64] and 2.66 [1.94 3.64], respectively.). The risk of cumulative all-cause mortality of up to 10 years was also worse in low- and medium-volume centers (HR [95% CI]; 1.96 [1.68 2.29] and 1.77 [1.47 2.12], respectively.). Discussion: Lower case-volume was associated with higher risk of mortality after mitral valve repair. A minimum case volume may be required for hospitals performing mitral valve repair to guarantee adequate patient outcome. REFERENCES: D’Agostino RS, Jacobs JP, Badhwar V, Paone G, Rankin JS, Han JM, et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Outcomes and Quality. Ann Thorac Surg. 2017;103(1):18-24. Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2017;52(4):616-64. Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(25):e1159-e95. Lazam S, Vanoverschelde JL, Tribouilloy C, Grigioni F, Suri RM, Avierinos JF, et al. Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation: Analysis of a Large, Prospective, Multicenter, International Registry. Circulation. 2017;135 (5):410-22. LaPar DJ, Ailawadi G, Isbell JM, Crosby IK, Kern JA, Rich JB, et al. Mitral valve repair rates correlate with surgeon and institutional experience. J Thorac Cardiovasc Surg. 2014;148 (3):995-1003; discussion-4.

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Methods: In this prospective observational study, we included patients who underwent open lobectomy. Cardiovascular markers were recorded postoperatively, in order to correlate the fluctuation of these markers with the application or not of thoracic epidural anesthesia. Results: Forty-eight (48) patients were enrolled, 15 (31.3%) received a combination of thoracic epidural anesthesia with general anesthesia, while 33 (68.7%) received general anesthesia alone. Patients with epidural anesthesia were found to have significantly lower levels of troponin 12-24 hours after surgery (8.9 § 4.1 versus 16.8 § 10.5, p <0.05), while 48 to 72 hours postoperatively, the troponin values of the two groups did not appear to differ (10.7 § 6.9 vs. 14.8 § 8.3, p 0.103). Age, sex and body mass index were not found to be significantly associated with the fluctuation of troponin values in this setting. Discussion: Patients who undergo open lobectomy receiving a combination of general and thoracic epidural anesthesia appear to maintain lower troponin levels in the immediate postoperative period than patients receiving general anesthesia alone. REFERENCES: 1. Minto G, Biccard B. Continuing Education in Anaesthesia. Critical Care & Pain 2014;14:127. 2. Korff S, Katus H, Giannitsis E. Differential diagnosis of elevated troponins. Heart 2006;92:98793. 3. VISION investigators et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA 2012;307:2295-304. 4. Sabesan M. Diagnostic markers of acute myocardial infarction. Biomed rep. 2015 Nov; 3(6): 743748. 5. Karzai W. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology 2009;110:1402-11. 6. Leslie K, Mcllroy D. Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial. Br J Anesth 2016;116:100-12. 7. Botto F. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology 2014;120:564-78.

Measurement of cardiac biomarkers in open lobectomies: comparison of combined thoracic epidural anesthesia with general anesthesia to general anesthesia alone

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A. Panagiotou1, A. Tsaroucha2, A. Chalkias3, S. Giannaraki1, C. Romana1

Encephalography guidance of anesthesia to alleviate geriatric syndromes (Engages-Canada) study in cardiac surgery patients: a pragmatic, randomized clinical trial

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Evaggelismos General Hospital of Athens, Athens, GREECE Aretaieion University Hospital of Athens, Athens, GREECE 3 Larissa University Hospital, Larissa, GREECE 2

Introduction: Troponin is a sensitive biomarker for cardiovascular injury. In lobectomies, perioperative analgesia can be performed with either a combination of thoracic epidural anesthesia and general anesthesia or general anesthesia alone. We wish to demonstrate that patients who receive the former tend to have lower levels of troponin.

J. Palermo1, C. Overbeek1, A. Dumont1, E. Jacobson2, R. El-Gabalwy2, M. Kavosh2, T. Saha3, R. Tanzola3, D. Dumertonshore3, M. Avidan4, J. Oberhaus4, A. Mickle4, G. Djaiani5, A. Deschamps1 1

Universit e de Montr eal, Montreal, CANADA University of Manitoba, Winnipeg, CANADA 3 Queen’s University, Kingston, CANADA 4 Washington University, Saint-Louis, MA, USA 5 University of Toronto, Toronto, CANADA 2