Enhanced recovery after surgery protocol in patients undergoing transapical transcatheter aortic valve implantation
- VernacularTitle:加速康复外科在心尖入路经导管主动脉瓣置入术患者中的应用
- Author:
YU Hong
1
,
2
;
XU Zhao
1
,
2
;
CHEN Yucheng
3
;
GUO Yingqiang
4
;
NI Hefeng
1
,
2
;
LIANG Peng
1
,
2
Author Information
1. Center of Anesthesiology &
2. Operating Room, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China
3. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China
4. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China
- Publication Type:Journal Article
- Keywords:
Transapical approach;
transcatheter aortic valve implantation;
enhanced recovery after surgery (ERAS);
risk factor
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2019;26(10):998-1003
- CountryChina
- Language:Chinese
-
Abstract:
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.
