Optimal Management of Patients Treated With Minimally Invasive Cardiac Surgery in the Era of Enhanced Recovery After Surgery and Fast-Track Protocols: A Narrative Review

Maj, Giulia; Regesta, Tommaso; Campanella, Antonio; Cavozza, C; Parodi, Giovanni; Audo, Andrea

doi:10.1053/j.jvca.2021.02.035

Cited by 31 publications

(15 citation statements)

References 46 publications

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“…In a review of the literature on ERAS and fast-track protocols in minimally invasive cardiac surgery, Maj et al reported that ERAS or fast-track protocols resulted in less blood transfusions, less pain, and overall lower mortality and fewer postoperative complications. 3 The few reports of fast-track pathways after minimally invasive CABG procedures have demonstrated relatively short LOS, as well, although not as short as the POD1 discharge in our study. Zaouter et al compared patients undergoing robotic pump-assisted TECAB with ERAS protocols to those undergoing open CABG with traditional perioperative care and found the hospital and ICU LOS in the TECAB group to be 4 days and 24 h shorter than the open group, respectively ( P < 0.05).…”

Section: Discussionsupporting

confidence: 49%

“…Minimally invasive and robotic coronary surgery have been shown to decrease hospital LOS. [2][3][4] We developed an ultrafast-track protocol for selected patients undergoing robotic totally endoscopic coronary bypass surgery (TECAB) to be discharged on postoperative day (POD) 1. The aim of this study was to describe the characteristics of patients discharged on POD1 after robotic TECAB in our practice and compare their outcomes to patients discharged after POD1.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Day 1 Discharge After Robotic Totally Endoscopic Coronary Bypass: The Ultimate in Enhanced Recovery After Surgery

Nisivaco

Patel

Coleman

et al. 2023

Innovations�(Phila)

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Objective: The benefits of Enhanced Recovery After Surgery (ERAS) protocols are being recognized in multiple surgical specialties, including following coronary bypass surgery to improve quality of care and decrease costs. We developed a fast-track discharge protocol for patients undergoing robotic totally endoscopic coronary bypass surgery (TECAB) to be discharged on postoperative day (POD) 1, the subjects of this study. Methods: In a retrospective study of 720 patients undergoing robotic beating-heart TECAB over 8 years at our institution, 93 patients were selected for a fast-track POD1 discharge protocol. We compared the outcomes of this group to the remaining 627 patients who were discharged per standard protocol (non-POD1 discharge). Results: The early discharge group was significantly younger, had lower Society of Thoracic Surgeons (STS) risk of mortality, and had a lower prevalence of obesity, diabetes, and chronic kidney disease. Patients discharged on POD1 were more often extubated in the operating room (56% vs 42%, P = 0.010). The readmission rate for the early discharge group was 3.2%, which was similar to the readmission rate of 6.7% for the standard discharge protocol group ( P = 0.329). Time to return to work was shorter in the early discharge group, although it did not quite reach statistical significance (12 vs 18 days, P = 0.051). There was no difference in midterm cardiac mortality. Conclusions: Early discharge on POD1 after robotic TECAB is appropriate in selected patients and is associated with low readmission rates and a trend towards earlier return to work. Patients suitable for this “ultrafast-track” approach were more likely to be younger, have lower STS risk, and fewer comorbidities.

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Section: Discussionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Postoperative Day 1 Discharge After Robotic Totally Endoscopic Coronary Bypass: The Ultimate in Enhanced Recovery After Surgery

Nisivaco

Patel

Coleman

et al. 2023

Innovations�(Phila)

View full text Add to dashboard Cite

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“…So-called fast track programs in the cardiac surgery were about two decades ago [48]. However, only few programs focus on minimally invasive surgery and in particular on the modern minimally invasive heart valve surgery [49]. Minimally invasive approaches in heart valve surgery have been demonstrated to be safe and associated with positive health outcomes [50].…”

Section: Discussionmentioning

confidence: 99%

Interdisciplinary and cross-sectoral perioperative care model in cardiac surgery: implementation in the setting of minimally invasive heart valve surgery (INCREASE)—study protocol for a randomized controlled trial

Klotz

Ketels

Behrendt

et al. 2022

Trials

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Background Valvular heart diseases are frequent and increasing in prevalence. Minimally invasive heart valve surgery embedded in an interdisciplinary enhanced recovery after surgery (ERAS) program may have potential benefits with regard to reduced length of stay and improved patient reported outcomes. However, no prospective randomized data exist regarding the superiority of ERAS program for the patients’ outcome. Methods We aim to randomize (1:1) a total of 186 eligible patients with minimally invasive heart valve surgery to an ERAS program vs. standard treatment at two centers including the University Medical Center Hamburg-Eppendorf, Germany, and the University Hospital Augsburg, Germany. The intervention is composed out of pre-, peri-, and postoperative components. The preoperative protocol aims at better preparation for the operation with regard to physical activity, nutrition, and psychological preparedness. Intraoperative anesthesiologic and surgical management are trimmed to enable an early extubation. Patients will be transferred to a specialized postoperative anesthesia care unit, where first mobilization occurs 3 h after surgery. Transfer to low care ward will be at the next day and discharge at the fifth day. Participants in the control group will receive treatment as usual. Primary endpoints include functional discharge at discharge and duration of in-hospital care during the first 12 months after index surgery. Secondary outcomes include health-related quality of life, health literacy, and level of physical activity. Discussion This is the first randomized controlled trial evaluating the effectiveness of an ERAS process after minimally invasive heart valve surgery. Interprofessional approach is the key factor of the ERAS process and includes in particular surgical, anesthesiological, physiotherapeutic, advanced nursing, and psychosocial components. A clinical implication guideline will be developed facilitating the adoption of ERAS model in other heart teams. Trial registration The study has been registered in ClinicalTrials.gov (NCT04977362 assigned July 27, 2021).

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“…However, only few programs focus on minimally invasive surgery and in particular on the modern minimally invasive heart valve surgery (49). Minimally invasive approaches in heart valve surgery have been demonstrated to be safe and associated with positive health outcomes (50).…”

Section: Discussionmentioning

confidence: 99%

Interdisciplinary and Cross-Sectoral Perioperative Care Model in Cardiac Surgery: Implementation in the Setting of Minimally-Invasive Heart Valve Surgery (INCREASE) – Study Protocol for a Randomized Controlled Trial

Klotz

Ketels

Behrendt

et al. 2022

Preprint

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Background Valvular heart diseases are frequent and increasing in prevalence. Minimally invasive heart valve surgery embedded in an interdisciplinary enhanced recovery after surgery (ERAS) program may have potential benefits with regard to reduced length of stay and improved patient reported outcomes. However, no prospective randomized data exist regarding the superiority of ERAS program for the patients’ outcome. Methods We aim to randomize (1:1) a total of 186 eligible patients with minimally invasive heart valve surgery to an ERAS program vs. standard treatment at two centers including the University Medical Center Hamburg-Eppendorf, Germany, and the University Hospital Augsburg, Germany. The intervention is composed out of pre-, peri- and postoperative components. The preoperative protocol aims at better preparation for the operation with regard to physical activity, nutrition, and psychological preparedness. Intraoperative anesthesiologic and surgical management are trimmed to enable an early extubation. Patients will be transferred to a specialized postoperative anesthesia care unit, where first mobilization occurs three hours after surgery. Transfer to low care ward will be at the next day and discharge at the fifth day. Participants in the control group will receive treatment as usual. Primary endpoints include functional discharge at discharge and duration of in-hospital care during the first twelve months after index surgery. Secondary outcomes include health-related quality of life, health literacy, and level of physical activity. Discussion This is the first randomized controlled trial evaluating the effectiveness of an ERAS process after minimally invasive heart valve surgery. Interprofessional approach is the key factor of the ERAS process and includes in particular surgical, anesthesiological, physiotherapeutic, advanced nursing and psychosocial components. A clinical implication guideline will be developed facilitating the adoption of ERAS model in other heart teams. Trial registration: The study has been registered in ClinicalTrials.gov (NCT04977362 assigned July 27th, 2021; https://www.clinicaltrials.gov/ct2/show/NCT04977362).

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Optimal Management of Patients Treated With Minimally Invasive Cardiac Surgery in the Era of Enhanced Recovery After Surgery and Fast-Track Protocols: A Narrative Review

Cited by 31 publications

References 46 publications

Postoperative Day 1 Discharge After Robotic Totally Endoscopic Coronary Bypass: The Ultimate in Enhanced Recovery After Surgery

Postoperative Day 1 Discharge After Robotic Totally Endoscopic Coronary Bypass: The Ultimate in Enhanced Recovery After Surgery

Interdisciplinary and cross-sectoral perioperative care model in cardiac surgery: implementation in the setting of minimally invasive heart valve surgery (INCREASE)—study protocol for a randomized controlled trial

Interdisciplinary and Cross-Sectoral Perioperative Care Model in Cardiac Surgery: Implementation in the Setting of Minimally-Invasive Heart Valve Surgery (INCREASE) – Study Protocol for a Randomized Controlled Trial

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