Epicardial Stimulation of the Cardiac Autonomic Nervous System

Isolated stimulation of the parasympathetic system induces a protective effect on long-term cardiac remodeling, but at the cost of inhibiting the sympathetic system. The role of the sympathetic system is to increase cardiac output in cases of acute heart failure.

Electrical stimulation of the cardiac plexus directly at the level of the heart allows simultaneous stimulation of the sympathetic and parasympathetic systems, whose complementary and not automatically antagonistic role is now recognized. Thus, direct stimulation of the plexus would optimize cardiac function in the short and long term by instantly improving cardiac output and decreasing pulmonary resistance as described in dogs by Kobayashi et al.

The objective of the EpiCANS study is to evaluate this technique in humans during cardiac surgery.

Inclusion criteria

• Scheduled for elective cardiac surgery for valvular or coronary surgery
• Having received written and oral information about the protocol and having signed a written informed consent
• Affiliated or beneficiary of a social security plan

Exclusion criteria

• Patient with an indication for cardiac surgery:
• Urgent or semi-urgent
• Aortic surgery
• Heart transplantation
• Mechanical circulatory assistance
• Patients who have already undergone cardiac surgery
• Adults under legal protection (safeguard of justice, curatorship, guardianship), persons deprived of liberty, pregnant or breastfeeding women, minors, persons unable to express their consent, persons hospitalized for a different reason