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Invited Critique
December 1, 2003

Reversible Cardiac Sympathectomy by High Thoracic Epidural Anesthesia Improves Regional Left Ventricular Function in Patients Undergoing Coronary Artery Bypass Grafting—Invited Critique

Arch Surg. 2003;138(12):1291. doi:10.1001/archsurg.138.12.1291

In this issue of the ARCHIVES, Berendes et al report improved regional left ventricular function when patients undergoing myocardial revascularization are protected with a transient cardiac sympathectomy by high TEA. We commend the authors on their timely and insightful clinical trial examining the effects of high TEA on regional and global myocardial function and perioperative risk in patients undergoing elective CABG while using a cardiac pump. Seventy-three patients with a left ventricular ejection fraction of 50% or more were randomized with 36 patients who received general anesthesia and high TEA and 37 patients who received only general anesthesia. The primary outcome measure was regional left ventricular function assessed via multiple slice transesophageal echocardiography. In addition, Berendes et al measured the levels of cardiac troponin I and the plasma concentrations of ANP that reflect atrial dilation while BNP indicates ventricular stress.1,2