Achieving Enhanced Recovery after Minimally Invasive Cardiac Surgery: A Single Center Experience

Background: Enhanced Recovery After Surgery (ERAS) is an interdisciplinary perioperative approach to improve recovery and reduce morbidity after major surgery in many different surgical fields. Core ERAS goals are extubation in the OR, transfer to a recovery unit instead of the ICU, early physiotherapy and early discharge from hospital. Minimally Invasive Cardiac Surgery (MICS) offers new opportunities for ERAS in cardiac surgery.

Methods: 358 consecutive patients underwent MICS and perioperative ERAS at our institution between 01/2021 and 03/2023. All-comers design was used for data analysis. Outcomes of interest were Major Adverse Cardiac Events (MACE), bleeding requiring reoperation, ERAS-associated complications (reintubation and readmission to the ICU), and ERAS achievement in five items: 1. extubation in the OR, 2. transfer to intermediate care instead of ICU, 3. physiotherapy within 24h, 4. transfer to the floor within 24h and 5. discharge from hospital within 7 days. Successful ERAS was defined as ≥ 3 items, partial as 1–2 items and failure as 0 items. Statistical testing was performed using the Mann-Whitney-U-Test for nonparametric data.

Results: Patients’ median age was 64 years (IQR 55–71) and 34% were female. 217 (61%) patients received anterolateral minithoracotomy for mitral and/or tricuspid valve surgery (n = 205), aortic valve replacement (n = 2) or other surgical procedures (n = 10). The remaining 141 (39%) patients had partial upper sternotomy for aortic valve repair/replacement (n = 99), aortic root/ascending surgery (n = 25) or both (n = 17). There were 8 (2%) MACE events and 13 (4%) instances of bleeding requiring reoperation. There were 4 (1%) reintubations and 5 (1%) readmissions to ICU. Postoperative recovery was scored in five items, in 294 (83%) patients ERAS was successful, in 34 (10%) patients it was partial, and 26 (7%) patients were treated with standard of care. Common risk factors including age, BMI and creatinine clearance were not significantly associated with the ERAS failure. However, reduced LVEF, EuroSCORE, STS Score and aortic cross clamp time were significantly associated with ERAS failure.

Conclusion: ERAS programs can be successful in cardiac surgery independent of patient age and other common comorbidities. However, intraoperative surgical complexity, preexisting HFrEF and high perioperative risk score may hinder ERAS success.

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Artikel online veröffentlicht:
13. Februar 2024