An enhanced recovery programme significantly improves postoperative outcomes after surgical aortic valve replacement

Albane Giger; Clément Schneider; Sandrine Marguerite; Dharmesh Ramlugun; Anne-Lise Maechel; Olivier Collange; Paul-Michel Mertes; Jean-Philippe Mazzucotelli; Michel Kindo

doi:10.1093/ejcts/ezad125

An enhanced recovery programme significantly improves postoperative outcomes after surgical aortic valve replacement

Eur J Cardiothorac Surg. 2023 May 2;63(5):ezad125. doi: 10.1093/ejcts/ezad125.

Authors

Albane Giger¹, Clément Schneider¹, Sandrine Marguerite², Dharmesh Ramlugun¹, Anne-Lise Maechel², Olivier Collange², Paul-Michel Mertes², Jean-Philippe Mazzucotelli¹, Michel Kindo¹

Affiliations

¹ Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
² Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.

PMID: 37014362
DOI: 10.1093/ejcts/ezad125

Abstract

Objectives: Evidence regarding the benefits of an enhanced recovery after cardiac surgery (ERACS) programme is lacking. The aim of this study was to analyse the impact of a systematic standardized ERACS programme for patients undergoing isolated elective surgical aortic valve replacement (SAVR) for aortic stenosis in terms of hospital mortality and morbidity, patient blood management and length of stay.

Methods: Patients undergoing isolated elective SAVR for aortic stenosis between 2015 and 2020 were identified from our database (n = 941). The standardized systematic ERACS programme was implemented in November 2018. Propensity score matching indicated that 259 patients would receive standard perioperative care (control group) and 259 patients would receive the ERACS programme (ERACS group). The primary outcome was hospital mortality. The secondary outcomes were hospital morbidity, patient blood management and length of stay.

Results: Both groups had similar hospital mortality rates (0.4%). The ERACS group had a significantly lower troponin I peak level (P < 0.001), a larger proportion of improved perioperative left ventricular ejection fractions (P = 0.001), a lower incidence of bronchopneumonia (P = 0.030), a larger proportion of patients with mechanical ventilation <6 h (P < 0.001), a lower incidence of delirium (P = 0.028) and less acute renal failure (P = 0.013). The ERACS group had a significantly lower rate of red blood cell transfusions (P = 0.002). The intensive care unit stay was significantly shorter in the ERACS group than in the control group (P = 0.039).

Conclusions: The standardized systematic ERACS programme significantly improved postoperative outcomes and should become the reference for the perioperative care pathway for patients undergoing SAVR.

Keywords: Aortic stenosis; Cardiac surgery; Cardiopulmonary bypass; Postoperative morbidity; Recovery; Surgical aortic valve replacement.

MeSH terms

Aortic Valve / surgery
Aortic Valve Stenosis* / surgery
Heart Valve Prosthesis Implantation*
Humans
Risk Factors
Treatment Outcome