Successful fast track protocol implementation for patients undergoing transapical transcatheter aortic valve implantation
| Autor: | Nestoras Papadopoulos, Stephan Fichtlscherer, Marlene Thudt, Christian Reyher, Andreas Zierer, Patrick Meybohm, Ali El-Sayed Ahmad, Anton Moritz |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty 030204 cardiovascular system & hematology law.invention Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Clinical Protocols Risk Factors law Germany Humans Medicine Heart valve replacement Percutaneous Aged Aged 80 and over Postoperative Care Transapical Ejection fraction business.industry Age Factors Mitral Valve Insufficiency EuroSCORE General Medicine Perioperative Length of Stay medicine.disease Intensive care unit Surgery Cardiac surgery Cardiac catheterization/intervention Intensive Care Units Treatment Outcome 030228 respiratory system Cardiothoracic surgery Fluoroscopy Heart valve prosthesis (bioprosthetic) Female Health Services Research Fast track Cardiology and Cardiovascular Medicine business Mitral valve regurgitation Research Article |
| Zdroj: | Journal of Cardiothoracic Surgery |
| ISSN: | 1749-8090 |
| DOI: | 10.1186/s13019-016-0449-4 |
| Popis: | Background The aim of the current study is to report our experience with fast-track treatment of patients undergoing transapical transcatheter aortic valve implantation (TA-TAVI) and to determine perioperative predictors for fast-track protocol failure. Methods Being one of the pioneering centers to start performing TA-TAVI back in 2005, we routinely included patients undergoing this procedure into our fast-track management program since 2008. Between January 2008 and June 2013, 207 consecutive high-risk patients (mean age 79 ± 7 years, mean Log. EuroSCORE 24 ± 10) who underwent TA-TAVI accordingly to our institutional fast-track approach were prospectively collected and analyzed. Uni- and multivariate analysis were performed to identify independent pre- and perioperative predictors of fast-track protocol failure, defined as inability to discharge the patient from the intensive care unit (ICU) on the day of surgery or as readmission to the ICU 48 h after the initial discharge. Results Fast-track management was successful in 83 % of the patients. 30-day mortality was 8 %. Fast-track protocol failure (17 %) was associated with an outcome worsening compared to the remaining patients (mortality: 40 % vs. 2 % and mean hospital stay: 19 ± 12 vs. 10 ± 9 days; P = .002). Independent predictors of fast-track protocol failure were age ≥85 years (OR 3.1; CI 95 % 1.89–6.21), ejection fraction (EF) ≤30 % (OR 2.6; CI 95 % 1.99–7.52), moderate to severe preoperative mitral valve regurgitation (OR 2.7; CI 95 % 1.27–6.43) and fluoroscopy time ≥12 min (OR 2.9; CI 95 % 1.28–7.46). Conclusions Fast-track patient management following TA-TAVI is safe and reproducible in the majority of patients. Besides patient-related preoperative risk factors (age ≥85 years, EF ≤30 % and moderate to severe preoperative mitral valve regurgitation) a technically challenging intraoperative course as evidenced in a prolonged fluoroscopy time are independent predictors of fast-track protocol failure which is associated with high loss of patient outcome. |
| Databáze: | OpenAIRE |
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