Pitts Leonard, Dini Martina, Goecke Simon, Kofler Markus, Ott Sascha, Stoppe Christian, O'Brien Benjamin, Jacobs Stephan, Falk Volkmar, Hommel Matthias, Kempfert Jörg
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Eur J Cardiothorac Surg. 2024 Nov 28;66(6). doi: 10.1093/ejcts/ezae439.
This study investigates our enhanced recovery after minimally invasive cardiac surgery program "enhanced recovery after minimally invasive cardiac surgery" (ERMICS) following a 'Zero ICU' concept compared to standard-of-care treatment in terms of safety and clinical efficacy.
All patients who underwent minimally invasive mitral valve surgery for primary severe mitral valve regurgitation between 2021 and 2023 were included. Propensity score matching (2:1) was performed between patients who received standard-of-care treatment and those who underwent ERMICS. Patients treated with the ERMICS approach were transferred to the peripheral ward instead of the intensive care unit on the day of surgery (Zero ICU). Separate primary end-points were safety (mortality, stroke), postoperative ventilation time and hospital length of stay.
A total of 611 patients (566 standard of care vs 45 ERMICS) were included in the study. After 2:1 matching, the cohort comprised 135 patients (90 standard of care vs 45 ERMICS) and were well balanced in terms of pre- and intraoperative variables. Thirty-day mortality was 0% in both groups. Postoperative ventilation time [P = 0.018, odds ratio (OR) < 0.01, confidence interval (CI) < 0.001], postoperative pain (P = 0.005, OR = 0.36, CI 0.18-0.74) and hospital length of stay (P = 0.049, OR = 0.28, CI 0.08-0.98) was significantly lower in ERMICS patients, while postoperative complications did not differ.
Our ERMICS 'Zero ICU' concept is safe and leads to significantly shorter postoperative ventilation time and hospital length of stay for patients undergoing minimally invasive mitral valve surgery for primary severe mitral valve regurgitation.
本研究调查了我们的微创心脏手术后强化康复计划“微创心脏手术后强化康复”（ERMICS），该计划遵循“零重症监护病房”概念，与标准治疗相比，在安全性和临床疗效方面的情况。
纳入2021年至2023年间因原发性重度二尖瓣反流接受微创二尖瓣手术的所有患者。在接受标准治疗的患者和接受ERMICS的患者之间进行倾向评分匹配（2:1）。采用ERMICS方法治疗的患者在手术当天被转移到外周病房而非重症监护病房（零重症监护病房）。独立的主要终点为安全性（死亡率、中风）、术后通气时间和住院时间。
本研究共纳入611例患者（566例接受标准治疗，45例接受ERMICS）。经过2:1匹配后，队列包括135例患者（90例接受标准治疗，45例接受ERMICS），术前和术中变量方面平衡良好。两组的30天死亡率均为0%。ERMICS组患者的术后通气时间[P = 0.018，优势比（OR）< 0.01，置信区间（CI）< 0.001]、术后疼痛（P = 0.005，OR = 0.36，CI 0.18 - 0.74）和住院时间（P = 0.049，OR = 0.28，CI 0.08 - 0.98）显著更低，而术后并发症无差异。
我们的ERMICS“零重症监护病房”概念是安全的，对于因原发性重度二尖瓣反流接受微创二尖瓣手术的患者，可显著缩短术后通气时间和住院时间。
