[MSB-13] Instutional ERAS Applications for Totally Endoscopic Mitral Valve Surgery

This study aimed to present our institutional protocol for enhanced recovery after surgery (ERAS) and its results in patients who underwent totally endoscopic mitral valve surgery (TEMVS).

One hundred thirteen consecutive patients (63 females, 50 males; mean age: 54.7 years) who underwent TEMVS between 2021 and 2023 were included in this study. The TEMVS was performed using a three-dimensional endoscopic technique. Institutional protocols were as follows: (i) education on operative course and cessation of smoking and alcohol; (ii) anemia; (iii) optimization of blood glucose; (iv) rehabilitation; (v) anxiety and analgesia treatment; (vi) blood conservation techniques such as antifibrinolytic, acute normovolemic hemodilution, miniincision, meticulous surgery by a three-dimensional endoscope; (vii) postoperative early extubation, prevention of nausea, aggressive analgesia, early mobilization, early removal of tubes; (viii) restrictive transfusion strategy; (ix) early discharge.

The rate of intravenous iron therapy for anemia was 26.5%. The repair rate of a degenerative mitral valve was 96.9%. Among all patients, 68.1% did not receive any erythrocyte suspension, and 15.9% had only one unit. The mean extubation time was 5 h. Ninety-six percent of Foley catheters, 87% of all central venous catheters, and 93% of all drainage tubes were removed on the first postoperative day. The rate of respiratory, infectious, and renal complications was 9%, 3.5%, and 3.4%, respectively. The median intensive care unit stay was 1 day, and the median hospitalization time was 5 days. There was one mortality in the early postoperative period.

Totally endoscopic mitral valve surgery provides lesser surgical trauma. By the addition of wellestablished ERAS protocols, less complication, less transfusion, early recovery, and greater patient satisfaction can be achieved.