Establishment of an enhanced recovery after surgery protocol in minimally invasive heart valve surgery
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Establishment of an enhanced recovery after surgery protocol in minimally invasive heart valve surgery. / Kubitz, Jens C; Schulte-Uentrop, Leonie; Zoellner, Christian; Lemke, Melanie; Messner-Schmitt, Aurelie; Kalbacher, Daniel; Sill, Björn; Reichenspurner, Hermann; Koell, Benedikt; Girdauskas, Evaldas.
in: PLOS ONE, Jahrgang 15, Nr. 4, e0231378, 2020.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Establishment of an enhanced recovery after surgery protocol in minimally invasive heart valve surgery
AU - Kubitz, Jens C
AU - Schulte-Uentrop, Leonie
AU - Zoellner, Christian
AU - Lemke, Melanie
AU - Messner-Schmitt, Aurelie
AU - Kalbacher, Daniel
AU - Sill, Björn
AU - Reichenspurner, Hermann
AU - Koell, Benedikt
AU - Girdauskas, Evaldas
PY - 2020
Y1 - 2020
N2 - Protocols for "Enhanced recovery after surgery (ERAS)" are on the rise in different surgical disciplines and represent one of the most important recent advancements in perioperative medical care. In cardiac surgery, only few ERAS protocols have been described in the past. At University Heart Center Hamburg, Germany, we invented an ERAS protocol for patients undergoing minimally invasive cardiac valve surgery. In this retrospective single center study, we aimed to describe the implementation of our ERAS program and to evaluate the results of the first 50 consecutive patients. Our ERAS protocol was developed according to a modified Kern cycle by an expert group, literature search, protocol creation and pilot implementation in the clinical practice. Data of the first 50 consecutive patients undergoing minimally invasive cardiac valve surgery were analysed retrospectively. The key features of our multidisciplinary ERAS protocol are physiotherapeutic prehabilitation, minimally invasive valve surgery techniques, modified cardiopulmonary bypass management, fast-track anaesthesia with on- table extubation and early mobilisation. A total of 50 consecutive patients (mean age of 51.9±11.9 years, mean STS score of 0.6±0.3) underwent minimally-invasive mitral or aortic valve surgery. The adherence to the ERAS protocol was high and neither protocol related complications nor in-hospital mortality occurred. 12% of the patients developed postoperative atrial fibrillation, postoperative delirium emerged in two patients and reintubation was required in one patient. Intensive care unit stay was 14.0±7.4 hours and total hospital stay 6.2±2.9 days. Our ERAS protocol is feasible and safe in minimally-invasive cardiac surgery setting and has a clear potential to improve patients outcome.
AB - Protocols for "Enhanced recovery after surgery (ERAS)" are on the rise in different surgical disciplines and represent one of the most important recent advancements in perioperative medical care. In cardiac surgery, only few ERAS protocols have been described in the past. At University Heart Center Hamburg, Germany, we invented an ERAS protocol for patients undergoing minimally invasive cardiac valve surgery. In this retrospective single center study, we aimed to describe the implementation of our ERAS program and to evaluate the results of the first 50 consecutive patients. Our ERAS protocol was developed according to a modified Kern cycle by an expert group, literature search, protocol creation and pilot implementation in the clinical practice. Data of the first 50 consecutive patients undergoing minimally invasive cardiac valve surgery were analysed retrospectively. The key features of our multidisciplinary ERAS protocol are physiotherapeutic prehabilitation, minimally invasive valve surgery techniques, modified cardiopulmonary bypass management, fast-track anaesthesia with on- table extubation and early mobilisation. A total of 50 consecutive patients (mean age of 51.9±11.9 years, mean STS score of 0.6±0.3) underwent minimally-invasive mitral or aortic valve surgery. The adherence to the ERAS protocol was high and neither protocol related complications nor in-hospital mortality occurred. 12% of the patients developed postoperative atrial fibrillation, postoperative delirium emerged in two patients and reintubation was required in one patient. Intensive care unit stay was 14.0±7.4 hours and total hospital stay 6.2±2.9 days. Our ERAS protocol is feasible and safe in minimally-invasive cardiac surgery setting and has a clear potential to improve patients outcome.
KW - Adult
KW - Aortic Valve/surgery
KW - Atrial Fibrillation/diagnosis
KW - Enhanced Recovery After Surgery
KW - Female
KW - Humans
KW - Intensive Care Units
KW - Length of Stay
KW - Male
KW - Middle Aged
KW - Minimally Invasive Surgical Procedures/adverse effects
KW - Mitral Valve/surgery
KW - Pain/etiology
KW - Postoperative Complications
KW - Retrospective Studies
KW - Treatment Adherence and Compliance
KW - Treatment Outcome
U2 - 10.1371/journal.pone.0231378
DO - 10.1371/journal.pone.0231378
M3 - SCORING: Journal article
C2 - 32271849
VL - 15
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 4
M1 - e0231378
ER -