Safety and feasibility of ultra-fast-track anesthesia for TAVR under the ERAS concept_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xiaoxia , WANG Hao , HUO Bin , WU Lin , GUO Wenwen ,  Lü Xinghua

Day Surgery Center, First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;

Corresponding?author：

Lü Xinghua, Email: ldyylxh18@163.com

Keywords：

Aortic-valve stenosis; transcatheter aortic valve replacement; ultra-fast-track anesthesia; enhanced recovery after surgery

DOI：

10.7507/1007-4848.202509012

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the safety and feasibility of ultra-fast-track anesthesia (UFTA) in transcatheter aortic valve replacement (TAVR) under the concept of enhanced recovery after surgery (ERAS). Methods A retrospective analysis was conducted on the clinical data of patients who underwent TAVR at the First Hospital of Lanzhou University between January 2022 and June 2024. Based on the anesthesia technique, patients were categorized into an ultra-fast-track anesthesia group (group U) and a conventional general anesthesia group (group C). The general patient characteristics, operative duration, length of hospital stay, hospitalization costs, and complications were compared between the two groups. Results A total of 101 patients were ultimately included in the study, comprising 60 males and 41 females, with a mean age of (67.85±7.73) years. Among them, 57 patients were assigned to the group U and 44 to group C. Compared with the group C, the group U showed significantly shorter postoperative extubation time (0.18 h vs. 4.88 h), CCU stay (22 h vs. 37 h), hospital stay (8 d vs.13 d), and lower hospitalization costs (234 300 yuan vs. 251 100 yuan) (P<0.05). In addition, the incidences of pulmonary infection (3.5% vs. 15.9%) and atelectasis (3.5% vs. 15.9%) within 30 days after surgery in the group U were significantly reduced (P<0.05).There was no statistically significant difference in the intraoperative mean arterial pressure, heart rate, or other complications such as postoperative arrhythmia, pervalvular leakage, and cerebral infarction between the two groups (P>0.05). Conclusion UFTA not only ensures the safety of TAVR patients, but also significantly enhances postoperative recovery, shortens recovery time, and optimizes medical resource utilization,.

1.	Maznyczka A, Prendergast B, Dweck M, et al. Timing of aortic valve intervention in the management of aortic stenosis. JACC Cardiovasc Interv, 2024, 17(21): 2502-2514.
2.	Madanat L, Allam M, Khalili H, et al. Long-term survival and quality of life following transcatheter aortic valve replacement in nonagenarians. Am J Cardiol, 2024, 213: 140-145.
3.	Pollock KM, Ambroziak R, Mullen C, et al. Outcomes related to cardiac enhanced recovery after surgery protocol. J Cardiothorac Vasc Anesth, 2023, 37(8): 1403-1409.
4.	Feng J, Wang H, Peng L, et al. The effect of ultra-fast track cardiac anaesthesia in infants and toddlers: a randomised trial. Cardiol Young, 2022, 32(7): 1092-1097.
5.	中國醫師協會心血管內科醫師分會結構性心臟病專業委員會. 中國經導管主動脈瓣置換術臨床路徑專家共識 (2021版). 中國循環雜志, 2022, 37(1): 12-23.Chinese Association of Cardiovascular Physicians, Society of Structural Heart Disease. Chinese expert consensus on clinical pathway for transcatheter aortic valve replacement (2021 edition). Chin Circ J, 2022, 37(1): 12-23.
6.	Rong LQ, Kamel MK, Rahouma M, et al. High-dose versus low-dose opioid anesthesia in adult cardiac surgery: a meta-analysis. J Clin Anesth, 2019, 57: 57-62.
7.	Caruso TJ, Lawrence K, Tsui BCH. Regional anesthesia for cardiac surgery. Curr Opin Anaesthesiol, 2019, 32(5): 674-682.
8.	Zhang TZ, Wu X. Review and prospect of accelerated rehabilitation cardiac surgery. J Clinic Anesthesiol, 2020, 36: 944-947.
9.	Cohen B, Turan A. Enhanced recovery after cardiacsurgery - Is evidence still necessary? J Clin Anesth752 Jiang et al. Ultra-fast-track cardiac anesthesia. Cardiovasc Diagn Ther, 2024, 14(5): 740-752.
10.	Noss C, Prusinkiewicz C, Nelson G, et al. Enhanced recovery for cardiac surgery. J Cardiothorac Vasc Anesth, 2018, 32: 2760-2770.
11.	Li M, Zhang J, Gan TJ, et al. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. Eur J Cardiothorac Surg, 2018, 54: 491-497.
12.	Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA Surg, 2019, 154: 755-766.
13.	Goeddel LA, Hollander KN, Evans AS. Early extubation after cardiac surgery: a better predictor of outcome than metric of quality? J Cardiothorac Vasc Anesth, 2018, 32: 745-747.
14.	Jiang T, Wang LX, Teng HK, et al. Ultra-fast-track cardiac anesthesia in minimally invasive cardiac surgery: a retrospective observational study. Cardiovasc Diagn Ther, 2024, 14(5): 740-752.
15.	Fang N, Ma B, Liu K, et al. Feasibility and safety of ultra-fast track anesthesia for totally thoracoscopic closure of ventricular septal defect: a randomized controlled trial. Heliyon, 2023, 9(5): e15741.
16.	Jiang S, Wang L, Teng H, et al. The clinical application of ultra-fast-track cardiac anesthesia in right-thoracoscopic minimally invasive cardiac surgery: a retrospective observational study. J Cardiothorac Vasc Anesth, 2023, 37(5): 700-706.
17.	Y?lmaz ?, Zeren G, Avc? ??, et al. The effect of anesthesia type applied in transcatheter aortic valve implantation. Turk Kardiyol Dern Ars, 2023, 51(6): 394-398.
18.	Xie CM, Yao YT. The current practice of transcatheter aortic valve replacement in China. J Card Surg, 2022, 37(10): 3168-3177.
19.	Svircevic V, Nierich AP, Moons KG, et al. Fast-track anesthesia and cardiac surgery: a retrospective cohort study of 7989 patients. Anesth Analg, 2009, 108(3): 727-733.
20.	Hawkins J, Khanna S, Argalious M. Sugammadex for reversal of neuromuscular blockade: uses and limitations. Curr Pharm Des, 2019, 25(19): 2140-2148.
21.	Chan JL, Miller JG, Murphy M, et al. A multi-disciplinary protocol-driven approach to improve extubation times after cardiac surgery. Ann Thorac Surg, 2018, 105(6): 1684-1690.
22.	Taylor M, Apparau D, Mosca R, et al. Does early extubation after cardiac surgery lead to a reduction in intensive care unit length of stay? Interact Cardiovasc Thorac Surg, 2022, 34(5): 731-734.
23.	James L, Smith DE, Galloway AC, et al. Routine extubation in the operating room after isolated coronary artery bypass. Ann Thorac Surg, 2024, 117(1): 87-94.
24.	Totonchi Z, Azarfarin R, Jafari L, et al. Feasibility of on-table extubation after cardiac surgery with cardiopulmonary bypass: a randomized clinical trial. Anesth Pain Med, 2018, 8(5): e80158.
25.	Garg R, Rao S, John C, et al. Extubation in the operating room after cardiac surgery in children: a prospective observational study with multidisciplinary coordinated approach. J Cardiothorac Vasc Anesth, 2014, 28(3): 479-487.
26.	Dong J, Lei Y, Wan Y, et al. Enhanced recovery after surgery from 1997 to 2022: a bibliometric and visual analysis. Updates Surg, 2024, 76(4): 1131-1150.
27.	Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med, 2020, 46(5): 888-906.
28.	Xu J, Zhou G, Li Y, et al. Benefits of ultra-fast-track anesthesia for children with congenital heart disease undergoing cardiac surgery. BMC Pediatr, 2019, 19(1): 487.

1. Maznyczka A, Prendergast B, Dweck M, et al. Timing of aortic valve intervention in the management of aortic stenosis. JACC Cardiovasc Interv, 2024, 17(21): 2502-2514.
2. Madanat L, Allam M, Khalili H, et al. Long-term survival and quality of life following transcatheter aortic valve replacement in nonagenarians. Am J Cardiol, 2024, 213: 140-145.
3. Pollock KM, Ambroziak R, Mullen C, et al. Outcomes related to cardiac enhanced recovery after surgery protocol. J Cardiothorac Vasc Anesth, 2023, 37(8): 1403-1409.
4. Feng J, Wang H, Peng L, et al. The effect of ultra-fast track cardiac anaesthesia in infants and toddlers: a randomised trial. Cardiol Young, 2022, 32(7): 1092-1097.
5. 中國醫師協會心血管內科醫師分會結構性心臟病專業委員會. 中國經導管主動脈瓣置換術臨床路徑專家共識 (2021版). 中國循環雜志, 2022, 37(1): 12-23.Chinese Association of Cardiovascular Physicians, Society of Structural Heart Disease. Chinese expert consensus on clinical pathway for transcatheter aortic valve replacement (2021 edition). Chin Circ J, 2022, 37(1): 12-23.
6. Rong LQ, Kamel MK, Rahouma M, et al. High-dose versus low-dose opioid anesthesia in adult cardiac surgery: a meta-analysis. J Clin Anesth, 2019, 57: 57-62.
7. Caruso TJ, Lawrence K, Tsui BCH. Regional anesthesia for cardiac surgery. Curr Opin Anaesthesiol, 2019, 32(5): 674-682.
8. Zhang TZ, Wu X. Review and prospect of accelerated rehabilitation cardiac surgery. J Clinic Anesthesiol, 2020, 36: 944-947.
9. Cohen B, Turan A. Enhanced recovery after cardiacsurgery - Is evidence still necessary? J Clin Anesth752 Jiang et al. Ultra-fast-track cardiac anesthesia. Cardiovasc Diagn Ther, 2024, 14(5): 740-752.
10. Noss C, Prusinkiewicz C, Nelson G, et al. Enhanced recovery for cardiac surgery. J Cardiothorac Vasc Anesth, 2018, 32: 2760-2770.
11. Li M, Zhang J, Gan TJ, et al. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. Eur J Cardiothorac Surg, 2018, 54: 491-497.
12. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA Surg, 2019, 154: 755-766.
13. Goeddel LA, Hollander KN, Evans AS. Early extubation after cardiac surgery: a better predictor of outcome than metric of quality? J Cardiothorac Vasc Anesth, 2018, 32: 745-747.
14. Jiang T, Wang LX, Teng HK, et al. Ultra-fast-track cardiac anesthesia in minimally invasive cardiac surgery: a retrospective observational study. Cardiovasc Diagn Ther, 2024, 14(5): 740-752.
15. Fang N, Ma B, Liu K, et al. Feasibility and safety of ultra-fast track anesthesia for totally thoracoscopic closure of ventricular septal defect: a randomized controlled trial. Heliyon, 2023, 9(5): e15741.
16. Jiang S, Wang L, Teng H, et al. The clinical application of ultra-fast-track cardiac anesthesia in right-thoracoscopic minimally invasive cardiac surgery: a retrospective observational study. J Cardiothorac Vasc Anesth, 2023, 37(5): 700-706.
17. Y?lmaz ?, Zeren G, Avc? ??, et al. The effect of anesthesia type applied in transcatheter aortic valve implantation. Turk Kardiyol Dern Ars, 2023, 51(6): 394-398.
18. Xie CM, Yao YT. The current practice of transcatheter aortic valve replacement in China. J Card Surg, 2022, 37(10): 3168-3177.
19. Svircevic V, Nierich AP, Moons KG, et al. Fast-track anesthesia and cardiac surgery: a retrospective cohort study of 7989 patients. Anesth Analg, 2009, 108(3): 727-733.
20. Hawkins J, Khanna S, Argalious M. Sugammadex for reversal of neuromuscular blockade: uses and limitations. Curr Pharm Des, 2019, 25(19): 2140-2148.
21. Chan JL, Miller JG, Murphy M, et al. A multi-disciplinary protocol-driven approach to improve extubation times after cardiac surgery. Ann Thorac Surg, 2018, 105(6): 1684-1690.
22. Taylor M, Apparau D, Mosca R, et al. Does early extubation after cardiac surgery lead to a reduction in intensive care unit length of stay? Interact Cardiovasc Thorac Surg, 2022, 34(5): 731-734.
23. James L, Smith DE, Galloway AC, et al. Routine extubation in the operating room after isolated coronary artery bypass. Ann Thorac Surg, 2024, 117(1): 87-94.
24. Totonchi Z, Azarfarin R, Jafari L, et al. Feasibility of on-table extubation after cardiac surgery with cardiopulmonary bypass: a randomized clinical trial. Anesth Pain Med, 2018, 8(5): e80158.
25. Garg R, Rao S, John C, et al. Extubation in the operating room after cardiac surgery in children: a prospective observational study with multidisciplinary coordinated approach. J Cardiothorac Vasc Anesth, 2014, 28(3): 479-487.
26. Dong J, Lei Y, Wan Y, et al. Enhanced recovery after surgery from 1997 to 2022: a bibliometric and visual analysis. Updates Surg, 2024, 76(4): 1131-1150.
27. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med, 2020, 46(5): 888-906.
28. Xu J, Zhou G, Li Y, et al. Benefits of ultra-fast-track anesthesia for children with congenital heart disease undergoing cardiac surgery. BMC Pediatr, 2019, 19(1): 487.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesSafety and feasibility of ultra-fast-track anesthesia for TAVR under the ERAS concept

Abstract Full text Figures/Tables Video References Cited by

Format

Content