Abstract
Purpose Avoidance of invasive ventilation after cardiac surgery is an attractive method to reduce the length of hospital stay and related complications. However there is limited experience about ultra-fast track anaesthesia (UFTA) in patients with end stage heart failure after left ventricular assist device (LVAD) implantation. This study aimed to investigate the outcomes of UFTA with extubation in operating theatre in patient receiving HeartMate 3 (HM3) implantation. Methods This study was an observational study. Between October 2015 and December 2017 all elective eligible patients for HM3 implantation in our department were included in this study. Exclusion criteria for UFTA were, inter alia, INTERMACS 1 and 2, preoperative invasive ventilation or forced expiratory volume in 1 second (FEV1) Results 45 patients received HM3 implantation in the mentioned period and 36 patients were eligible for UFTA. UFTA was successfully performed in 27.7 %. Distribution of preoperative risk factors was similar between groups. Patients in UFTA group had significantly lower incidences of pneumonia (p =0.001), septic shock (p=0.045) and right ventricular failure (RVF) (p=0.024). They showed a significantly higher cardiac index in the first 24h. (p=0.012); a significantly lower central venous pressure during the first 24h. postoperatively (p=0.005) and a significantly better central venous saturation after the first 6h postoperatively and continuing to 24h postoperatively (p=0.011). Additionally, intensive care unit (ICU) stay (p=0.006) was significantly shorter in the UFTA group. Kaplan-Meier analysis revealed no significant difference in the 30-days survival. Conclusion In this pilot study, we demonstrated the feasibility of ultra-fast-track anesthesia in HM3 patients with INTERMACS level 3-4. Patients had a lower incidence of postoperative complications, better hemodynamic performance, and shorter length of ICU stay and lower incidence of RVF after UFTA. Prospective investigations are encouraged to evaluate the capability of UFTA for sustainable protection of right ventricular function, and these studies should aim to identify useful criteria for adequate patient stratification.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
