Foreword: Fast track in aortic valve surgery

Abstract

‘Fast track’ in cardiac surgery includes early extubation, a short stay in the intensive care unit, and early discharge from the hospital.1 Although several centres were familiar with an early extubation of selected low-risk cardio-surgical patients in the odds ratio , the term ‘Fast Track’ was first coined in the 1990s.2 Limited resources were the main driving force for the development of more standardized fast track protocols when huge cardiac programs of more than 10 surgical cases a day required reliable intensive care unit (ICU) capacities. In most cardiac centres, so called intermediate care units (IMC) were established in these days also, to improve the ‘flow’ of patients and close the gap between ICU and care in a standard ward. The comprehensive care in intermediate care units with extended monitoring and specialized staff, usually in a 1–4 nurse-patient ratio, made early extubation and avoidance of the ICU for low risk cardio-surgical patients, notably CABG in younger ages, possible.3–6 The evolution of less invasive techniques in cardiac surgery, such as the off-pump coronary bypass surgery, further stimulated the fast track programs, which not only benefitted patients but also aimed to improve the cost effectiveness of cardiac surgical programs.7 Nowadays, cardiac surgery is faced with an increasing number of elderly, frail, and comorbid patients. The number of …