Benefits of ultra-fast-track anesthesia in left ventricular assist device implantation: a retrospective, propensity score matched cohort study of a four-year single center experience

Abstract

BackgroundThe use of left ventricular assist devices (LVADs) has gained significant importance for treatment of end-stage heart failure. Fast-track procedures are well established in cardiac surgery, whereas knowledge of their benefits after LVAD implantation is sparse. We hypothesized that ultra-fast-track anesthesia (UFTA) with in-theater extubation or at a maximum of 4 h. after surgery is feasible in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 3 and 4 patients and might prevent postoperative complications.MethodsFrom March, 2010 to March, 2012, 53 LVADs (50 Heart Mate II and 3 Heart Ware) were implanted in patients in our department. UFTA was successfully performed (LVADultra) in 13 patients. After propensity score matching, we compared the LVADultra group with a matched group (LVADmatch) receiving conventional anesthesia management.ResultsPatients in the LVADultra group had significantly lower incidences of pneumonia (p = 0.031), delirium (p = 0.031) and right ventricular failure (RVF) (p = 0.031). They showed a significantly higher cardiac index in the first 12 h. (p = 0.017); a significantly lower central venous pressure during the first 24 h. postoperatively (p = 0.005) and a significantly shorter intensive care unit (ICU) stay (p = 0.016). Kaplan-Meier analysis after four years of follow-up showed no significant difference in survival.ConclusionIn this pilot study, we demonstrated the feasibility of ultra-fast-track anesthesia in LVAD implantation in selected patients with INTERMACS level 3–4. Patients had a lower incidence of postoperative complications, better hemodynamic performance, shorter length of ICU stay and lower incidence of RVF after UFTA. Prospective randomized investigations should examine the preservation of right ventricular function in larger numbers and identify appropriate selection criteria.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-017-0573-9) contains supplementary material, which is available to authorized users.

Evaluation of analgesic and sedative effects of remifentanil‐based fast‐track anesthesia in children undergoing transthoracic device closure of ventricular septal defects

“…The goal of fast‐track cardiac anesthesia is to reduce stress, relieve pain, and speed recovery, reduce hospitalization costs, and save medical resources. This technology's fundamental purpose is to replace long‐acting opioids with short‐acting opioids or to reduce the dosage of long‐acting opioids combined with inhaled anesthetics and other short‐acting intravenous anesthetics to achieve early recovery of spontaneous breathing and circulation 5,6,13–15 . Fast‐track anesthesia has been applied and studied in pediatric congenital cardiac surgery, but its application in transthoracic device closure of pediatric congenital VSDs under TEE guidance is rarely reported.…”

Effect of remifentanil-based fast-track anesthesia on postoperative analgesia and sedation in adult patients undergoing transthoracic device closure of ventricular septal defect

“…Sevoflurane was a commonly used inhalation anesthetic, and atracurium was an auxiliary anesthetic; all of them were safe and effective and high tolerance for the patients [ 29 ]. Fast-track anesthesia could effectively avoid stress stimulation of patients, promote the prognosis of patients, improve the effectiveness of surgical treatment, and reduce the days of hospitalization [ 30 ].…”

Early Against Classic Extubation Outcomes Following Cardiac Surgery and Correlation With Rapid Shallow Breath Index

“…It is correlated with lower rates of respiratory complications and lower use of resources and becomes a common goal of postoperative recovery after cardiac surgery. [2,3] Weaning from mechanical ventilatory support (MVS) continues to be an erroneous technique and dependent mainly on clinicians' experiences. Some parameters and calculated formulas like the ratio of respiratory frequency (f ) to tidal volume(Vt)-also known as rapid shallow breath index (RSBI) -is used widely to standardize weaning from MVS and to predict failure of attempt.…”