Successful fast track protocol implementation for patients undergoing transapical transcatheter aortic valve implantation

Abstract

BackgroundThe aim of the current study is to report our experience with fast-track treatment of patients undergoing transapical transcatheter aortic valve implantation (TA-TAVI) and to determine perioperative predictors for fast-track protocol failure.MethodsBeing one of the pioneering centers to start performing TA-TAVI back in 2005, we routinely included patients undergoing this procedure into our fast-track management program since 2008. Between January 2008 and June 2013, 207 consecutive high-risk patients (mean age 79 ± 7 years, mean Log. EuroSCORE 24 ± 10) who underwent TA-TAVI accordingly to our institutional fast-track approach were prospectively collected and analyzed. Uni- and multivariate analysis were performed to identify independent pre- and perioperative predictors of fast-track protocol failure, defined as inability to discharge the patient from the intensive care unit (ICU) on the day of surgery or as readmission to the ICU 48 h after the initial discharge.ResultsFast-track management was successful in 83 % of the patients. 30-day mortality was 8 %. Fast-track protocol failure (17 %) was associated with an outcome worsening compared to the remaining patients (mortality: 40 % vs. 2 % and mean hospital stay: 19 ± 12 vs. 10 ± 9 days; P = .002). Independent predictors of fast-track protocol failure were age ≥85 years (OR 3.1; CI 95 % 1.89–6.21), ejection fraction (EF) ≤30 % (OR 2.6; CI 95 % 1.99–7.52), moderate to severe preoperative mitral valve regurgitation (OR 2.7; CI 95 % 1.27–6.43) and fluoroscopy time ≥12 min (OR 2.9; CI 95 % 1.28–7.46).ConclusionsFast-track patient management following TA-TAVI is safe and reproducible in the majority of patients. Besides patient-related preoperative risk factors (age ≥85 years, EF ≤30 % and moderate to severe preoperative mitral valve regurgitation) a technically challenging intraoperative course as evidenced in a prolonged fluoroscopy time are independent predictors of fast-track protocol failure which is associated with high loss of patient outcome.

Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review

“…It is also related to preoperative anxiety, pain, preparation, risk factors and the patient's knowledge and expectations of the surgical process (Ayyadhah Alanazi, 2014; Husted, 2012; Johansson Stark et al, 2014; McClurkin & Smith, 2016; Pettersson et al, 2017). Two papers analyse fast‐track surgical procedures and conclude that abbreviating the perioperative period and facilitating prompt discharge significantly enhance clinical results (Dries, 2018; Papadopoulos et al, 2016). These findings corroborate Vogl et al, (2015), who suggested that a shorter hospital stay was not associated with worse health outcomes after 6 months.…”

“…Among the articles reviewed, the two most frequent years of publication were 2018 (Brown et al, 2018;Dries, 2018;Wyatt et al, 2018) and 2020 (Derseh et al, 2020;da Silva Schulz et al, 2020;Vogl et al, 2015) (n = 3), followed by 2012 (Husted, 2012;Johansson Stark et al, 2014), 2015 (Crump et al, 2015;Liederbach et al, 2015) (n = 2), 2011 (Papadopoulos et al, 2016), 2014(Ayyadhah Alanazi, 2014(McClurkin & Smith, 2016, 2017 (Pettersson et al, 2017(de Lorenzo-Pinto et al, 2019. None of these articles were published in 2013 or 2021 (Figure 2).…”

“…Of the 18 articles originally considered, three were discarded because the corresponding QATSDD score obtained was less than 65% (Perlini et al, 2020;Taylor et al, 2020). This cut-off point was established of based on reference 2014;Brown et al, 2018;Crump et al, 2015;Derseh et al, 2020;Dries, 2018;Husted, 2012;Johansson Stark et al, 2014;Liederbach et al, 2015;de Lorenzo-Pinto et al, 2019;McClurkin & Smith, 2016;Papadopoulos et al, 2016;Pettersson et al, 2017;da Silva Schulz et al, 2020;Vogl et al, 2015;Wyatt et al, 2018) (Table 2).…”

“…Among the articles reviewed, the two most frequent years of publication were 2018 (Brown et al, 2018;Dries, 2018;Wyatt et al, 2018) and 2020 (Derseh et al, 2020;da Silva Schulz et al, 2020;Vogl et al, 2015) (n = 3), followed by 2012 (Husted, 2012;Johansson Stark et al, 2014), 2015 (Crump et al, 2015;Liederbach et al, 2015) (n = 2), 2011 (Papadopoulos et al, 2016), 2014 (Ayyadhah Alanazi, The articles reviewed were conducted in 18 countries and five continents. By location, the largest number of articles originated from the United States (17%), followed by Germany (10%), Australia, Brazil, Canada, United Kingdom and Sweden (7% each) and Austria, China, Denmark, Spain, Ethiopia, Finland, France, Islamic Republic of Iran, Iceland, Japan and Norway (3% each) (Figure 3).…”

Comparison effects of two muscle relaxant strategies on postoperative pulmonary complications in transapical transcatheter aortic valve implantation: a propensity score-matched analysis

“…Because of the minimally invasive nature of the TAVI approach, patients undergoing TAVI represent a suitable cohort for early recovery [ 6 ]. However, transapical-TAVI (TA-TAVI) procedures need sufficiently profound neuromuscular blockade (NMB) during surgery which improves surgical conditions by inhibiting skeletal muscle movements.…”