Rapid-Recovery Protocol for Minimally Invasive Mitral Valve Repair

Abstract

ObjectiveMinimally invasive mitral valve repair (MIMVR), often performed within specialized care pathways, has been shown to reduce length of stay and improve patient recovery. The relative value of rapid-recovery protocols as a component of care pathways, including enhanced recovery programs (ERP), has not been well described. This study compares clinical outcomes following implementation of a new, comprehensive rapid-recovery protocol within a previously established, mature ERP for MIMVR. MethodsThe rapid-recovery protocol was developed and implemented by a multidisciplinary team to further optimize patient recovery within an existing ERP. The protocol was applied to 75 consecutive patients undergoing MIMVR from September 2022 to December 2023. Outcomes were retrospectively compared to 75 ERP control patients who did not receive the rapid-recovery protocol, but experienced the ERP. The primary outcome was a composite of discharge from the intensive care unit (ICU) by postoperative day (POD)#1, discharge to home by POD#4, and no all-cause hospital readmission by 30-days. ResultsBaseline characteristics were similar between the two groups. Patients in the rapid-recovery group achieved the primary composite outcome significantly more than the control group (60% versus 40%, respectively). There was no difference in postoperative complications. Multivariable logistic regression showed that age ≤ 60 years was significantly associated with rapid-recovery protocol success. Clinical barriers to achieving individual components of the primary outcome were described. ConclusionsA rapid-recovery protocol for MIMVR was associated with early ICU and hospital discharge. These benefits were safely achieved, without any increase in hospital readmission, morbidity, or mortality to 30-days postoperatively.