Optimal management of patients treated with minimally invasive cardiac surgery in the era of Enhanced Recovery after Surgery and fast-track protocols: a narrative review

ABSTRACT Background and Aim of the Study : Minimally invasive cardiac surgery (MICS) has been increasingly used in the last years. However, to exert its maximal effect on patient outcome, MICS needs to be coupled with improved perioperative management including Enhanced Recovery after Surgery (ERAS) and fast-track protocols. This study aimed to evaluate the impact of ERAS and fast-track in this context. Materials and Methods : We performed a narrative review including patients treated with MICS and treated with ERAS/fast-track protocols. MEDLINE/PubMed database was used. The keywords “ERAS”, “fast-track” were combined with the keywords: minimally invasive cardiac surgery OR robotic cardiac surgery OR minimally invasive mitral surgery OR minimally invasive aortic surgery. Results : Overall, six studies were selected in which either ERAS or fast-track protocols were applied. The reported adherence to ERAS protocols was high and neither protocol related complications nor in-hospital mortality occurred. Patients managed with ERAS had significantly lower postoperative pain scores, fewer rates of blood transfusions as well as shorter hospital and intensive unit stay as compared to those who received standard management. All ERAS patients were safely managed with early extubation. Similarly, fast- track cardiac surgery with immediate post-procedure extubation and early transfer to the ward showed to be safe with no increased morbidity or mortality. Conclusion : Use of standardized ERAS and fast-track protocols seem to be feasible and safe in the context of minimally-invasive cardiac surgery with improved outcome. Both ERAS and fast-track allow for a faster return to full functional status while minimizing the perioperative complications.