Ertugay Serkan, Karaca Sedat, Engin Ayşen Yaprak, Kahraman Ümit, Ünlü Zehra, Kocabaş Seden, Çalkavur Tanzer, Özbaran Mustafa
Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Türkiye.
Department of Anesthesiology, Ege University Faculty of Medicine, Izmir, Türkiye.
Front Cardiovasc Med. 2024 Oct 10;11:1398438. doi: 10.3389/fcvm.2024.1398438. eCollection 2024.
One of the philosophies of minimally invasive mitral surgery is to enhance recovery after surgery (ERAS). Beyond surgical applications, ERAS applications provide a complementary approach to optimize postoperative course and discharge. In this report, we aim to present institutional protocol for ERAS and its results in patients who underwent totally endoscopic mitral valve surgery (TEMVS).
Between 2021 and 2023, totally 113 patients who underwent TEMVS were included in this study. TEMVS was performed by peripheral cannulation and 3D endoscopic technique. As a dedicated team, institutional ERAS protocols which are used are listed above: (1) Education; operative course, cessation of smoking and alcohol. (2) Anemia; diagnostic evaluation and its treatment by iv iron. (3) Optimization of blood glucose; checking of HbA1c and control of hyperglycemia. (4) Rehabilitation; Physical and pulmonary rehabilitation. (5) Anxiety and Analgesia treatment. (6) Blood Conservation techniques; Antifibrinolytic, acute normovolemic hemodilution, less priming volume, mini-incision, meticulous surgery by 3D endoscope. (7) Postoperative; early extubation, prevention of nausea, aggressive analgesia, early mobilization, early removal of tubes. (8) Restrictive transfusion strategy. (9) Early discharge.
The mean age was 54.7 years, and 56% was female. The rate of iv iron therapy for anemia was 26.5%. Mitral repair was performed in 58.4% of the cases. The repair rate of degenerative mitral valve was 96.9%. Of all, 68.1% did not have any red packed cells and 15.9% had only one unit. Ninety-five patients (90.2%) did not have any unit of fresh frozen plasma. The median extubation time was 7 h. On the postoperative first day, 96% of foley catheters, 87% of all central venous catheter and 93% of all drainage tubes are removed. The rates of respiratory, infectious, and renal complications were 9%, 3.5%, 3.4% respectively. The median ICU, and hospital stays were 1 and 5 days respectively. There was only one mortality in the early postoperative period.
Totally endoscopic mitral valve surgery provides minimal surgical trauma. By the addition of well-established and nurse-based ERAS protocols, complication and transfusion rates can be decreased, early recovery and discharge can be provided.
微创二尖瓣手术的理念之一是促进术后恢复（加速康复外科，ERAS）。除了手术应用外，ERAS应用提供了一种优化术后病程和出院的补充方法。在本报告中，我们旨在介绍ERAS的机构方案及其在接受全内镜二尖瓣手术（TEMVS）患者中的结果。
2021年至2023年期间，本研究共纳入113例接受TEMVS的患者。TEMVS通过外周插管和3D内镜技术进行。作为一个专门的团队，使用的机构ERAS方案如下：（1）教育；手术过程、戒烟和戒酒。（2）贫血；诊断评估及静脉注射铁剂治疗。（3）血糖优化；检查糖化血红蛋白（HbA1c）并控制高血糖。（4）康复；身体和肺部康复。（5）焦虑和镇痛治疗。（6）血液保护技术；抗纤溶、急性等容血液稀释、较少预充量、小切口、3D内镜精细手术。（7）术后；早期拔管、预防恶心、积极镇痛、早期活动、早期拔除引流管。（8）限制性输血策略。（9）早期出院。
平均年龄为54.7岁，女性占56%。贫血患者静脉注射铁剂治疗率为26.5%。58.4%的病例进行了二尖瓣修复。退行性二尖瓣修复率为96.9%。总体而言，68.1%的患者未输注任何红细胞，15.9%的患者仅输注了一个单位。95例（90.2%）患者未输注任何单位的新鲜冰冻血浆。中位拔管时间为7小时。术后第一天，96%的导尿管、87%的中心静脉导管和93%的引流管被拔除。呼吸、感染和肾脏并发症发生率分别为9%、3.5%、3.4%。中位重症监护病房（ICU）住院时间和住院时间分别为1天和5天。术后早期仅有1例死亡。
全内镜二尖瓣手术创伤极小。通过增加成熟的、以护士为主导的ERAS方案，可以降低并发症和输血率，实现早期康复和出院。
