Use of a high thoracic epidural analgesia for treatment of end-stage congestive heart failure secondary to coronary artery disease: effect of HTEA on CHF.

We present the case of a patient with end-stage congestive heart failure (NYHA class IV) secondary to ischemic cardiomyopathy despite maximally medical therapy, who needed to have a coronary artery bypass graft (CABG) surgery but whose risk was considered too high due to his deteriorating cardiac function. Cardiac sympathetic blockade by high thoracic epidural analgesia (HTEA) was added to stabilize the patient's critical condition before surgery. HTEA was performed at the T1 through T5 levels with a catheter placed percutaneously and then lidocaine (0.5%, 3-5 ml) was given as intermittent injections through the epidural catheter. The combination of HTEA treatment resulted in a rapid hemodynamic and clinical improvement and no serious catheter-related complications occurred. This case suggests that HTEA seems to be an effective and safe adjuvant therapeutics and can be used as a short-term bridge to CABG or cardiac transplantation in patients with end-stage congestive heart failure.