Thorac Cardiovasc Surg 2011; 59 - V130
DOI: 10.1055/s-0030-1269136

Cardiac fast track anesthesia can contribute to an improved outcome in elderly patients undergoing minimally invasive aortic valve replacement

K Denk 1, I Tzanova 2, I Karliova 1, D Ister 1, A Peivandi 1, J Albers 1, C Werner 2, CF Vahl 1
  • 1Johannes Gutenberg University Hospital, Departments of Cardiothoracic- and Vascular Surgery, Mainz, Germany
  • 2Johannes Gutenberg University Hospital, Department of Anesthesiology, Mainz, Germany

Objectives: Minimally-invasive cardiac surgery with fast-track anaesthesia is commonly used for geriatric patients. In this retrospective study we evaluate whether fast-track anaesthesia and early tracheal extubation promotes early mobilization and improved outcome in elderly patients (>75 years).

Methods: 88 patients (79.8±3.7 years) underwent minimally invasive aortic valve replacement (MIC-AVR) via J sternotomy. 62 patients got conventional (CON) anesthesia with Midazolam, Propofol, Atracurium, Desfluran and Sufentanil; 26 patients had fast track anesthesia (FAST) with Propofol, Remifentanil, Piritramid, Isofluran, Atracurium and low dose Midazolam and Sufentanil for induction. The clinical parameter were similar in both groups including NYHA classification (averaging NYHA III) and Euro Score. 25.8%CON and 38.5%FAST patients had preoperative evaluated pulmonary dysfunction.

Results: Ventilation time was 17.2 (±15.1)h in CON and 11.8 (±7.0)h in FAST patients. 51.6%CON and 76.9% FAST were discharged from ICU after 24h (p<0.0001) as 19.2% CON and 38.7%FAST got mobilized (p<0.0001). Organic psychosyndrome was shown by 17.7% CON and 7.7% FAST patients (p=0.014). Due to respiratory insufficiency 9.7% CON and 7.7%FAST patients needed re-intubation. 2 CON got tracheotomy and 3 CON patients died by reason of bronchopneumonia. No FAST patient needed tracheotomy and no one died at all.

Conclusion: Cardiac Fast track anesthesia realizes early extubation and mobilization and improves the outcome of elderly patients undergoing MIC-AVR. Complications as bronchopulmonary infection and organic psychosyndrome are becoming rare. The anesthesiological treatment with short operating drugs and effective analgesia is of significant importance for the whole perioperative fast track concept including MIC-AVR and short ICU-hospitalization.