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Maximizing Minimally Invasive Cardiac Surgery With Enhanced Recovery (ERAS)
Rawn Salenger1, Niv Ad2, Michael C Grant3
1Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Abstract:
We convened a group of cardiac surgeons, intensivists, and anesthesiologists with extensive experience in minimally invasive cardiac surgery (MICS) and perioperative care to identify the essential elements of a MICS program and the relationship with Enhanced Recovery After Surgery (ERAS). The MICS incision should minimize tissue invasion without compromising surgical goals. MICS also requires safe management of hemodynamics and preservation of cardiac function, which we have termed myocardial management. Finally, comprehensive perioperative care through an ERAS program should be provided to allow patients to achieve optimal recovery. Therefore, we propose that MICS requires 3 elements: (1) a less invasive surgical incision (non-full sternotomy), (2) optimized myocardial management, and (3) ERAS. We contend that the full benefit of MICS can be achieved only by also utilizing an ERAS platform.
Insights
Minimally invasive cardiac surgery (MICS) requires a less invasive incision, optimized myocardial management, and Enhanced Recovery After Surgery (ERAS) for optimal patient recovery. Integrating MICS with ERAS maximizes surgical benefits.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Minimally invasive cardiac surgery (MICS) offers benefits but requires specific perioperative strategies.
- Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient outcomes postoperatively.
- The integration of MICS and ERAS is crucial for maximizing the advantages of less invasive cardiac procedures.
Purpose of the Study:
- To identify the essential components of a successful MICS program.
- To define the relationship between MICS and ERAS protocols.
- To propose a framework for optimal MICS implementation and patient recovery.
Main Methods:
- Convened a multidisciplinary expert panel including cardiac surgeons, intensivists, and anesthesiologists.
- Discussed and defined key elements of MICS, including surgical approach and myocardial management.
- Analyzed the role and integration of ERAS principles within the MICS perioperative pathway.
Main Results:
- MICS necessitates a less invasive surgical incision (non-full sternotomy) to minimize tissue invasion.
- Effective "myocardial management" is essential for hemodynamic stability and cardiac function preservation.
- Comprehensive perioperative care via ERAS is critical for achieving optimal patient recovery after MICS.
Conclusions:
- A successful MICS program is built upon three pillars: less invasive incision, optimized myocardial management, and ERAS.
- The full benefits of MICS are realized when implemented in conjunction with an ERAS pathway.
- This integrated approach ensures superior outcomes and recovery for cardiac surgery patients.
