Enhanced recovery after surgery protocol in patients undergoing transapical transcatheter aortic valve implantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Hong ¹ , XU Zhao ¹ , CHEN Yucheng ² , GUO Yingqiang ³ , NI Hefeng ¹ ,  LIANG Peng ¹

1. Center of Anesthesiology & Operating Room, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
3. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

LIANG Peng, Email: liangpeng_world@foxmail.com

Keywords：

Transapical approach; transcatheter aortic valve implantation; enhanced recovery after surgery (ERAS); risk factor

DOI：

10.7507/1007-4848.201903016

Video：

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Objective To report our experience with enhanced recovery after surgery (ERAS) protocol in patients undergoing transapical transcatheter aortic valve implantation (TAVI) and to determine perioperative predictors for ERAS failure. Methods Between May 2018 and January 2019, 80 patients undergoing TAVI in our hospital were recruited. Among them, 40 patients (24 males, 16 females, aged 73.0±5.0 years) successfully received ERAS, defined as successful extubation in operating room (an ERAS group) and the other 40 patients (28 males, 12 females, aged 73.0±7.0 years, a non-ERAS group) failed to perform ERAS. Results Compared with the non-ERAS group, patients in the ERAS group were associated with a significantly lower incidence of postoperative complications (30.0% vs. 52.5%, P=0.04), shorter postoperative ICU stay (2.2±0.4 d vs. 4.0±4.8 d, P=0.00) and hospital stay (7.0±2.3 d vs. 9.5±4.8 d, P=0.00), and less medical cost (311±20 thousand yuan vs. 347±80 thousand yuan, P=0.00). Independent predictors of ERAS failure were poor preoperative heart function and elevated B-type natriuretic peptides. Conclusion ERAS protocol is feasible and effective in patients undergoing TAVI. Poor preoperative heart function is an independent predictor of failure in early extubation which, in turn, is associated with prolonged ICU and hospital stay and dramatic worsening of patient outcomes.

Citation： YU Hong, XU Zhao, CHEN Yucheng, GUO Yingqiang, NI Hefeng, LIANG Peng. Enhanced recovery after surgery protocol in patients undergoing transapical transcatheter aortic valve implantation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(10): 998-1003. doi: 10.7507/1007-4848.201903016 Copy

1.	Lassen K, Hannemann P, Ljungqvist O, et al. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ, 2005, 330(7505): 1420-1421.
2.	Wong WT, Lai VK, Chee YE, et al. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev, 2016, 9: CD003587.
3.	Brown JK, Singh K, Dumitru R, et al. The benefits of enhanced recovery after surgery programs and their application in cardiothoracic surgery. Methodist Debakey Cardiovasc J, 2018, 14(2): 77-88.
4.	Fleming IO, Garratt C, Guha R, et al. Aggregation of marginal gains in cardiac surgery: feasibility of a perioperative care bundle for enhanced recovery in cardiac surgical patients. J Cardiothorac Vasc Anesth, 2016, 30(3): 665-670.
5.	陈永聪, 赖可可. 经导管主动脉瓣置入术的麻醉. 心血管病防治知识(下半月), 2015, 11: 88-90.
6.	Thomas M, Schymik G, Walther T, et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation, 2010, 122(1): 62-69.
7.	Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
8.	Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
9.	Sola M, Ramm CJ, Kolarczyk LM, et al. Application of a multidisciplinary enhanced recovery after surgery pathway to improve patient outcomes after transcatheter aortic valve implantation. Am J Cardiol, 2016, 118(3): 418-423.
10.	许钊, 邱静萱, 朱达, 等. 70 例心尖入路经导管主动脉瓣植入术患者的麻醉管理. 中国胸心血管外科临床杂志, 2018, 25(8): 701-706.
11.	Sirio CA, Martich GD. Who goes to the ICU postoperatively? Chest, 1999, 115(5 Suppl): 125S-129S.
12.	Barash PG, Lescovich F, Katz JD, et al. Early extubation following pediatric cardiothoracic operation: a viable alternative. Ann Thorac Surg, 1980, 29(3): 228-233.
13.	Gall SA Jr, Olsen CO, Reves JG, et al. Beneficial effects of endotracheal extubation on ventricular performance. Implications for early extubation after cardiac operations. J Thorac Cardiovasc Surg, 1988, 95(5): 819-827.
14.	Haanschoten MC, van Straten AH, ter Woorst JF, et al. Fast-track practice in cardiac surgery: results and predictors of outcome. Interact Cardiovasc Thorac Surg, 2012, 15(6): 989-994.
15.	Papadopoulos N, El-Sayed Ahmad A, Thudt M, et al. Successful fast track protocol implementation for patients undergoing transapical transcatheter aortic valve implantation. J Cardiothorac Surg, 2016, 11(1): 55.
16.	Chamchad D, Horrow JC, Nachamchik L, et al. The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital lengths of stay. J Cardiothorac Vasc Anesth, 2010, 24(5): 780-784.
17.	Mikami D, Nakazawa H, Moriyama K, et al. Utility of brain natriuretic peptide (BNP) to predict outcomes of patients undergoing elective cardiac surgery. Masui, 2014, 63(2): 138-142.
18.	Murad Junior JA, Nakazone MA, Machado Mde N, et al. Predictors of mortality in cardiac surgery: brain natriuretic peptide type B. Rev Bras Cir Cardiovasc, 2015, 30(2): 182-187.
19.	Subramaniam K, DeAndrade DS, Mandell DR, et al. Predictors of operating room extubation in adult cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(5): 1656-1665.
20.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.

1. Lassen K, Hannemann P, Ljungqvist O, et al. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ, 2005, 330(7505): 1420-1421.
2. Wong WT, Lai VK, Chee YE, et al. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev, 2016, 9: CD003587.
3. Brown JK, Singh K, Dumitru R, et al. The benefits of enhanced recovery after surgery programs and their application in cardiothoracic surgery. Methodist Debakey Cardiovasc J, 2018, 14(2): 77-88.
4. Fleming IO, Garratt C, Guha R, et al. Aggregation of marginal gains in cardiac surgery: feasibility of a perioperative care bundle for enhanced recovery in cardiac surgical patients. J Cardiothorac Vasc Anesth, 2016, 30(3): 665-670.
5. 陈永聪, 赖可可. 经导管主动脉瓣置入术的麻醉. 心血管病防治知识(下半月), 2015, 11: 88-90.
6. Thomas M, Schymik G, Walther T, et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation, 2010, 122(1): 62-69.
7. Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
8. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
9. Sola M, Ramm CJ, Kolarczyk LM, et al. Application of a multidisciplinary enhanced recovery after surgery pathway to improve patient outcomes after transcatheter aortic valve implantation. Am J Cardiol, 2016, 118(3): 418-423.
10. 许钊, 邱静萱, 朱达, 等. 70 例心尖入路经导管主动脉瓣植入术患者的麻醉管理. 中国胸心血管外科临床杂志, 2018, 25(8): 701-706.
11. Sirio CA, Martich GD. Who goes to the ICU postoperatively? Chest, 1999, 115(5 Suppl): 125S-129S.
12. Barash PG, Lescovich F, Katz JD, et al. Early extubation following pediatric cardiothoracic operation: a viable alternative. Ann Thorac Surg, 1980, 29(3): 228-233.
13. Gall SA Jr, Olsen CO, Reves JG, et al. Beneficial effects of endotracheal extubation on ventricular performance. Implications for early extubation after cardiac operations. J Thorac Cardiovasc Surg, 1988, 95(5): 819-827.
14. Haanschoten MC, van Straten AH, ter Woorst JF, et al. Fast-track practice in cardiac surgery: results and predictors of outcome. Interact Cardiovasc Thorac Surg, 2012, 15(6): 989-994.
15. Papadopoulos N, El-Sayed Ahmad A, Thudt M, et al. Successful fast track protocol implementation for patients undergoing transapical transcatheter aortic valve implantation. J Cardiothorac Surg, 2016, 11(1): 55.
16. Chamchad D, Horrow JC, Nachamchik L, et al. The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital lengths of stay. J Cardiothorac Vasc Anesth, 2010, 24(5): 780-784.
17. Mikami D, Nakazawa H, Moriyama K, et al. Utility of brain natriuretic peptide (BNP) to predict outcomes of patients undergoing elective cardiac surgery. Masui, 2014, 63(2): 138-142.
18. Murad Junior JA, Nakazone MA, Machado Mde N, et al. Predictors of mortality in cardiac surgery: brain natriuretic peptide type B. Rev Bras Cir Cardiovasc, 2015, 30(2): 182-187.
19. Subramaniam K, DeAndrade DS, Mandell DR, et al. Predictors of operating room extubation in adult cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(5): 1656-1665.
20. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.

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