Fast-track protocols in proximal aortic repair: teamwork makes the dream work.

Abstract

It is not news that patients and, with them, the whole medical and scientific world are attracted to the prospect of less-invasive procedures in cardiac surgery. During the last decades, the concept of invasiveness has classically been linked to the size of the skin incision, but it also concerns the surgical and cardiopulmonary bypass techniques and the anaesthetic management. Fast-track protocols in cardiac surgery are aimed at early extubation and a shortened Intensive Care Unit (ICU) stay. These techniques have proved to be safe in low- or moderate-risk patients [1], but they have mostly been used in patients undergoing CABG procedures and minimally invasive mitral or aortic valve surgery. In their recent manuscript, Leipzig’s group [2] provided interesting data showing how fast-track protocols can be applied in complex aortic surgery as well. Using a propensity score matching, the authors compared 197 elective Bentall procedures who underwent conventional perioperative management with 197 patients receiving a fast-track protocol. The latter were subjected to early extubation in a postoperative anaesthetic care unit and then transferred to the intermediate care unit. Their retrospective study showed non-inferiority in the fast-track group, with no difference in intraoperative, intrahospital and follow-up outcomes. The fast-track group obviously presented shorter ICU stays (6.7 vs 21.7 h) and ventilation times (165 vs 517 min), but there was no difference in the total hospital stay [2]. The manuscript is well written and results are consistent.