Routine Extubation in the Operating Room After Minimally Invasive Aortic Valve Replacement

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Thoracic Surgery

Background:

• Aortic valve replacement (AVR) via right anterior mini-thoracotomy (RAMT) is a minimally invasive surgical approach.
• The safety and feasibility of early extubation in the operating room (on-table) following RAMT-AVR have not been fully established.

Purpose of the Study:

• To evaluate the feasibility and safety of on-table extubation after isolated AVR performed through RAMT.
• To identify predictors of successful on-table extubation in this patient cohort.

Main Methods:

• Retrospective analysis of 423 patients undergoing isolated AVR via RAMT (February 2012 - December 2023).
• Exclusion of emergency cases and reoperations.
• Categorization based on extubation location: operating room (on-table) vs. intensive care unit (ICU).
• Multivariable logistic regression to determine predictors of on-table extubation.

Main Results:

• 73.3% of patients were extubated on-table.
• On-table extubation was associated with younger age, lower EuroSCORE II, higher preoperative albumin, and shorter cardiopulmonary bypass times.
• On-table extubation significantly reduced ICU and hospital length of stay.
• A predictive model (age, albumin, bypass time) achieved ~78.4% accuracy for on-table extubation success.

Conclusions:

• On-table extubation is safe and effective for most patients undergoing isolated AVR via RAMT.
• This practice is linked to low reintubation rates and shorter hospitalizations.
• Routine on-table extubation is supported for suitable candidates undergoing RAMT-AVR.