OBJECTIVES
Few data are available regarding early extubation after mitral valve surgery. We sought to assess the impact of an Enhanced Recovery After Surgery based protocol—ultra-fast track protocol—in patients undergoing minimally invasive transaxillary mitral valve surgery.
METHODS
Data of patients who underwent transaxillary mitral valve surgery associated with ultra-fast track protocol between 2018 and 2023 were reviewed. We compared preoperative, intraoperative and postoperative data of patients who had fast track extubation (≤6 hours since the end of the procedure) and non-fast track extubation (>6 hours) and, within the fast track group, patients who underwent on table extubation and patients who were extubated in Intensive Care Unit within 6 hours. Multivariable logistic regression was used to study the association of extubation timing and Intensive Care Unit stay, postoperative stay and discharge home.
RESULTS
Three-hundred fifty-six patients were included in the study. Two-hundred eighty-two patients underwent fast track extubation (79%) and 160 were extubated on table (45%). We found no difference in terms of mortality and occurrence of major complications (overall mortality and cerebral stroke 0.3%) according to the extubation timing. Fast track extubation was associated with shorter Intensive Care Unit stay, discharge home and discharge home within postoperative day 7 when compared to non-fast track extubation. Within the fast track group, on table extubation was associated with Intensive Care Unit stay ≤ 1 day and discharge home within postoperative day 7.
CONCLUSIONS
Fast track extubation was achievable in most of the patients undergoing transaxillary minimally invasive mitral valve surgery and was associated with higher rates of day 1 Intensive Care Unit discharge and discharge home. On table extubation was associated with further reduced Intensive Care Unit stay and hospitalization.