Fast track minimally invasive transmyocardial revascularization

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Procedures
• Patient Discharge Protocols

Background:

• End-stage ischemic coronary artery disease (CAD) often necessitates advanced treatment options.
• Minimally invasive cardiac surgery offers potential benefits over traditional open-heart procedures.
• Optimizing postoperative care pathways is crucial for efficient patient recovery and resource utilization.

Purpose of the Study:

• To evaluate the initial outcomes of a fast-track discharge protocol for patients undergoing minimally invasive transmyocardial revascularization (MiTMR).
• To assess the feasibility and safety of rapid discharge following MiTMR.
• To determine the impact of this protocol on patient recovery, hospital stay, and financial outcomes.

Main Methods:

• Fifteen male patients with ischemic CAD underwent MiTMR using robotic-assisted thoracoscopic techniques.
• A standardized fast-track postoperative protocol included immediate extubation, early removal of invasive monitoring lines, and early mobilization.
• Patient data including operative details, postoperative complications, length of stay, and 30-day outcomes were collected and analyzed.

Main Results:

• The majority of patients (80%) were discharged within 23 hours, with an overall mean hospital length of stay of 1.4 days.
• No operative arrhythmias or in-hospital mortalities were observed.
• Mild-to-moderate cardiomyopathy did not correlate with prolonged hospital stay; however, three patients experienced atelectasis, and one 30-day readmission for atrial fibrillation occurred.

Conclusions:

• A fast-track discharge protocol is effective for most patients undergoing MiTMR, enabling rapid return home.
• The perioperative morbidity and mortality rates associated with this approach are low, even in high-risk patients.
• The protocol demonstrates a modest positive hospital profit margin, suggesting economic viability.