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, Aurélie; Kalbacher, Daniel; Sill, B.; Reichenspurner, Hermann; Koell, Benedikt; Girdauskas, Evaldas

doi:10.1371/journal.pone.0231378

Cited by 34 publications

(25 citation statements)

References 25 publications

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“…ERAS uses evidence-based, multimodal perioperative care pathways to improve perioperative patient experience and outcomes. [18][19][20][21][22][23] Opioids were traditionally the cornerstone of pain management, but all contemporary ERAS programs recommend minimizing their use, due to the numerous side effects, as well as the ongoing opioid crisis that led to 9.7 million people misusing prescription pain relievers and more than 48,000 deaths due to synthetic opioids (excluding methadone) in 2019. [24][25][26][27] These programs instead advocate the implementation of a combination of locoregional (Fig.…”

Section: Introductionmentioning

confidence: 99%

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Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

Sherazee

Chen

et al. 2022

Innovations�(Phila)

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Section: Introductionmentioning

confidence: 99%

“…ERAS uses evidence-based, multimodal perioperative care pathways to improve perioperative patient experience and outcomes. 18–23…”

Section: Introductionmentioning

confidence: 99%

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

Sherazee

Chen

et al. 2022

Innovations�(Phila)

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“…A good QoL after cardiac surgery is undoubtedly a goal that cardiac surgery departments must offer their patients today. It is likely that the integration of a minimally invasive surgery program combined with physiotherapeutic prehabilitation, fast-track anesthesia, and early mobilization [22][23][24] will help in reaching this goal.…”

Section: Discussionmentioning

confidence: 99%

Chronic postsurgical pain and quality of life after right minithoracotomy mitral valve operations

Toscano

Barbero

Capuano

et al. 2022

Journal of Cardiac Surgery

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Objectives: Chronic postsurgical pain (CPSP) is a relatively common complication after cardio-thoracic operations with well-known consequences in terms of return to normal activities and quality of life. Little is known about the prevalence and severity of CPSP after minimally invasive cardiac surgery. The aim of this study was to measure the rate of CPSP in patients undergoing right minithoracotomy mitral valve (MV) surgery and to compare the effectiveness of different approaches to pain control. Methods: A prospective observational study was conducted between March 2019 and September 2020. All patients undergoing right minithoracotomy MV surgery treated with morphine, continuous serratus anterior plane block (SAPB), or continuous erector spinae plane block (ESPB) were included. The Brief Pain Inventory questionnaire was used to evaluate 6-month CPSP and quality of life.Results: A total of 100 patients were enrolled: postoperative pain control was obtained with morphine in 26 cases, with SAPB in 37 cases, and with ESPB in 37 cases. Median intensive care unit and hospital length of stay were 1 day and 6 days, respectively. Pain severity index was lower than 10 in 81 patients, and no differences were recorded between groups (p = .59). No patients reported chronic use of medications for pain management or severe pain interference in daily activities at follow-up.Discussion: Right minithoracotomy approach is not burdened by a high incidence of CPSP: pain severity index was lower than 10 in more than 90% of patients. Then, in our experience, chronic pain seems not to be related to the type of perioperative analgesia adopted.

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“…After the procedure, the patient is relocated to the ICU for further surveillance in our clinic while first centers focus on early extubation in the OR [12]. The procedure itself requires a multidisciplinary team approach, including surgeons, cardiac anesthesiologists, a perfusionist, and scrub nurses.…”

Section: Methodsmentioning

confidence: 99%

Pass On What You Have Learned: A Structured Mentor-Mentee Concept for the Implementation of a Minimally Invasive Mitral Valve Surgery Program

et al. 2021

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Introduction: Starting a minimally invasive cardiac surgery (MICS) for mitral valve repair (MVR) program is challenging as it requires a new learning curve, but compromising surgical results at the same time is not acceptable. Here, we describe our surgical educational experience of starting a new MICS program at a university heart center in Germany. Methods: A dedicated team for the new MICS program including 2 cardiac surgeons, 1 cardiac anesthetist, 1 perfusionist, and 1 scrub nurse was chosen. The use of long shafted instruments was trained in a low-cost self-assembled MICS simulator, and the EACTS endoscopic dry lab course was visited. Thereafter, 1 MICS center was visited for direct observation and peer-to-peer education for 6 weeks. The mentor observed the first 10 cases performed by the mentee. The surgical mitral valve expertise of 1 single cardiac surgeon was retrospectively analyzed between April 2016 and April 2021. Results: Before the implementation of the MICS-MVR program, 18 mitral valve operations have been performed through sternotomy between April 2016 and October 2018 including 12 replacements and 6 ring annuloplasties. After starting the MICS-MVR program, 73 mitral operations have been performed by the same surgeon of which 53 video-assisted through minithoracotomy (72.6%). 83.1% of the MICS procedures included complex repair (n = 38) and ring annuloplasty (n = 6). Open heart MV surgery was necessary in 20 patients due to concomitant procedures (n = 8), redo procedures (n = 2), severe endocarditis (n = 4), or contraindication for MICS such as PAD (n = 6). There have been no deaths, 1 stroke, and 1 cardiac vascular (RCX) complication. Two patients required conversion to sternotomy and one pericardiocentesis in the long term. Conclusion: Typically, excellent exposure and high repair rates of the MV has led us offer MICS approach to a majority of patients with isolated MV disease. Careful planning and a strict mentor-mentee concept facilitated a safe startup of an MICS program in a busy university heart center.

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Establishment of an enhanced recovery after surgery protocol in minimally invasive heart valve surgery

Abstract: 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.

Cited by 34 publications

References 25 publications

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

Chronic postsurgical pain and quality of life after right minithoracotomy mitral valve operations

Pass On What You Have Learned: A Structured Mentor-Mentee Concept for the Implementation of a Minimally Invasive Mitral Valve Surgery Program

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