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Reduced Length of Hospital Stay for Mini-Invasive Aortic Valve Replacements after implementation of an Enhanced Recovery After Surgery Program
Pierre OSES, Sr., Cedrick Zaouter, Jocelyn Duchateau, Alexandre Ouattara, Louis Labrousse.
Bordeaux University Hospital, PESSAC, France.

OBJECTIVE: There is presently a warm enthusiasm for enhanced recovery after surgery (ERAS) program. A recent review indicates that length of hospital stay and postoperative complication could be reduced by 30 and 50%, respectively. However, most of the studies analyzed encompassed solely colorectal and orthopedic surgeries. Only one retrospective ERAS program has been described for mini-invasive cardiac surgery. Thus, in an effort to provide more evidence to the literature we have investigated prospectively the feasibility and clinical effectiveness of a dedicated ERAS program for mini-invasive Aortic Valve Replacements (AVR).
METHODS: Data were collected prospectively from consecutive patients scheduled for an AVR via a ministernotomy during 2 time periods, before (PRE-AVRERAS group) and after application of a dedicated ERAS pathway specifically designed for this mini-invasive cardiac procedure (AVRERAS group). Operative data, postoperative morphine consumption, postoperative data of interest, postoperative infection rates, types and rate of complications, 30-day type and rates of readmission were collected
RESULTS: There were 22 patients in the PRE-AVRERAS group, and 14 in the AVRERAS group. The median length of hospital stay was 9 days in the PRE-AVRERAS group compared to 5 days the AVRERAS group (P < 0.05). The results of postoperative interest are described in table 1. An ERAS pathway envisioned for mini-invasive AVR seems feasible and associated with a shorter length of hospital stay.
CONCLUSIONS: Our study indicates that an ERAS pathway could be implemented effectively with interesting results when a mini-invasive AVR is planned.
Operative and post operative data of interest
PRE¬-AVRERAS (n=22)AVRERAS (n=14)P¬Value
Logistic Euroscore12.4±4.115.5±3.20.06
Cross clamp time min.68±15.541±8.20.002
Sutureless valve implantation n(%)014(100)<0.001
Postoperative morphine consumption8±103±30.079
Mobilization on a chair on the day of the surgery; n(%)0(0)11(79)< 0.001
Transurethral catheter removal on the morning after surgery n(%)1(4.5)9(64)<0.001
Overall infections during the hospitalization; n(%)8(36)1(7)0.06
Readmission for cardiac reasons; n(%)2(9)0(0)0.51
Extubation in operative room n(%)013(92.8)<0.001

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