Goecke Simon, Pitts Leonard, Dini Martina, Montagner Matteo, Wert Leonhard, Akansel Serdar, Kofler Markus, Stoppe Christian, Ott Sascha, Jacobs Stephan, O'Brien Benjamin, Falk Volkmar, Hommel Matthias, Kempfert Jörg
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Medicina (Kaunas). 2025 Mar 13;61(3):495. doi: 10.3390/medicina61030495.
: Minimally invasive valve surgery (MIVS), integrated within enhanced recovery after surgery (ERAS) programs, is a pivotal advancement in modern cardiac surgery, aiming to reduce perioperative morbidity and accelerate recovery. This systematic review analyzes the integration of ERAS components into MIVS programs and evaluates their impact on perioperative outcomes and patient recovery. : A systematic search of PubMed/Medline, conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, identified studies on ERAS in MIVS patients. Coronary and robotic surgery were excluded to prioritize widely adopted minimally invasive valve methods. Studies were included if they applied ERAS protocols primarily to MIVS patients, with at least five participants per study. Data on study characteristics, ERAS components, and patient outcomes were extracted for analysis. : Eight studies met the inclusion criteria, encompassing 1287 MIVS patients (842 ERAS, 445 non-ERAS). ERAS protocols in MIVS were heterogeneous, with studies implementing 9 to 18 of 24 ERAS measures recommended by the ERAS consensus guideline, reflecting local hospital practices and resource availability. Common elements include patient education and multidisciplinary teams, early extubation followed by mobilization, multimodal opioid-sparing pain management, and timely removal of invasive lines. Despite protocol variability, these programs were associated with reduced morbidity, shorter hospital stays (intensive care unit-stay reductions of 4-20 h to complete omission, and total length of stay by ≥1 day), and cost savings of up to EUR 1909.8 per patient without compromising safety. : ERAS protocols and MIVS synergistically enhance recovery and reduce the length of hospital stay. Standardizing ERAS protocols for MVS could amplify these benefits and broaden adoption.
微创瓣膜手术（MIVS）融入手术后加速康复（ERAS）计划，是现代心脏手术的一项关键进展，旨在降低围手术期发病率并加速康复。本系统评价分析了ERAS各组成部分融入MIVS计划的情况，并评估了它们对围手术期结局和患者康复的影响。
根据PRISMA（系统评价和Meta分析的首选报告项目）指南，对PubMed/Medline进行系统检索，确定了关于MIVS患者ERAS的研究。排除冠状动脉和机器人手术，以便优先考虑广泛采用的微创瓣膜方法。如果研究主要将ERAS方案应用于MIVS患者，且每项研究至少有五名参与者，则纳入研究。提取有关研究特征、ERAS组成部分和患者结局的数据进行分析。
八项研究符合纳入标准，涵盖1287例MIVS患者（842例接受ERAS，445例未接受ERAS）。MIVS中的ERAS方案各不相同，各研究实施了ERAS共识指南推荐的24项ERAS措施中的9至18项，这反映了当地医院的做法和资源可用性。共同要素包括患者教育和多学科团队、早期拔管后活动、多模式阿片类药物节省疼痛管理以及及时拔除侵入性导管。尽管方案存在差异，但这些计划与发病率降低、住院时间缩短（重症监护病房住院时间减少4至20小时甚至完全省略，总住院时间缩短≥1天）以及每位患者节省高达1909.8欧元的费用相关，且不影响安全性。
ERAS方案和MIVS协同增强康复并缩短住院时间。标准化MVS的ERAS方案可以扩大这些益处并促进其更广泛的应用。
