Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Feb 8;12(1):10.
doi: 10.1186/s13019-017-0573-9.

Benefits of ultra-fast-track anesthesia in left ventricular assist device implantation: a retrospective, propensity score matched cohort study of a four-year single center experience

Rashad Zayat  1 , Ares K Menon  2 , Andreas Goetzenich  2 , Gereon Schaelte  3 , Ruediger Autschbach  2 , Christian Stoppe  4 , Tim-Philipp Simon  4 , Lachmandath Tewarie  2 , Ajay Moza  2
Affiliations

Benefits of ultra-fast-track anesthesia in left ventricular assist device implantation: a retrospective, propensity score matched cohort study of a four-year single center experience

Rashad Zayat et al. J Cardiothorac Surg. .

Abstract

Background: The use of left ventricular assist devices (LVADs) has gained significant importance for treatment of end-stage heart failure. Fast-track procedures are well established in cardiac surgery, whereas knowledge of their benefits after LVAD implantation is sparse. We hypothesized that ultra-fast-track anesthesia (UFTA) with in-theater extubation or at a maximum of 4 h. after surgery is feasible in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 3 and 4 patients and might prevent postoperative complications.

Methods: From March, 2010 to March, 2012, 53 LVADs (50 Heart Mate II and 3 Heart Ware) were implanted in patients in our department. UFTA was successfully performed (LVAD ultra ) in 13 patients. After propensity score matching, we compared the LVAD ultra group with a matched group (LVAD match ) receiving conventional anesthesia management.

Results: Patients in the LVAD ultra group had significantly lower incidences of pneumonia (p = 0.031), delirium (p = 0.031) and right ventricular failure (RVF) (p = 0.031). They showed a significantly higher cardiac index in the first 12 h. (p = 0.017); a significantly lower central venous pressure during the first 24 h. postoperatively (p = 0.005) and a significantly shorter intensive care unit (ICU) stay (p = 0.016). Kaplan-Meier analysis after four years of follow-up showed no significant difference in survival.

Conclusion: In this pilot study, we demonstrated the feasibility of ultra-fast-track anesthesia in LVAD implantation in selected patients with INTERMACS level 3-4. Patients had a lower incidence of postoperative complications, better hemodynamic performance, shorter length of ICU stay and lower incidence of RVF after UFTA. Prospective randomized investigations should examine the preservation of right ventricular function in larger numbers and identify appropriate selection criteria.

Keywords: Fast-track-anesthesia; Left ventricular assist device; Postoperative complication; Right ventricular failure.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Patients groups and study design. BMI: Body mass index kg/m2; COPD: Chronic obstructive lung disease; CVA: Cerebrovascular accident; FEV1%: Ratio of forced expiratory volume in 1 s (FEV1)/ Forced vital capacity (FVC); INTERMACS: Interagency Registry for Mechanically Assisted Circulatory Support; LVAD: Left ventricular assist device; LVADconv: All LVAD patients, who received conventional anesthesia; LVADmatch: LVAD patients, who received conventional anesthesia and were matched with the 13 patients who received ultra-fast-track anesthesia; LVADultra: Patients, who had ultra-fast-track anesthesia
Fig. 2
Fig. 2
Cumulative number of patients extubated by postoperative hour. OR: Operating room
Fig. 3
Fig. 3
Hemodynamic parameters during 24 h postoperative. *: indicates significance; CI: cardiac index L/min/m2; CVP: central venous pressure mmHg, ScvO2: central venous saturation %; MPAP: mean pulmonary artery pressure mmHg. P-values were carried out with one-way ANOVA test with Sidak’s correction
Fig. 4
Fig. 4
Survival proportions. CI: cardiac index L/min/m2; CVP: central venous pressure mmHg, ScvO2: central venous saturation %; MPAP: mean pulmonary artery pressure mmHg. Bold writing indicates significance
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zhu F, Lee A, Chee YE. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev. 2012;10:CD003587. - PubMed
    1. Svircevic V, Nierich AP, Moons KG, Brandon Bravo Bruinsma GJ, Kalkman CJ, van Dijk D. Fast-track anesthesia and cardiac surgery: a retrospective cohort study of 7989 patients. Anesth Analg. 2009;108(3):727–33. doi: 10.1213/ane.0b013e318193c423. - DOI - PubMed
    1. Cheng DCH, Wall C, Djaiani G, Peragallo RA, Carroll J, Li C, et al. Randomized assessment of resource use in fast-track cardiac surgery 1-year after hospital discharge. Anesthesiology. 2003;98(3):651–7. doi: 10.1097/00000542-200303000-00013. - DOI - PubMed
    1. Plumer H, Markewitz A, Marohl K, Bernutz C, Weinhold C. Early extubation after cardiac surgery: a prospective clinical trial including patients at risk. Thorac Cardiovasc Surg. 1998;46(5):275–80. doi: 10.1055/s-2007-1010238. - DOI - PubMed
    1. Kianfar AA, Ahmadi ZH, Mirhossein SM, Jamaati H, Kashani BS, Mohajerani SA, et al. Ultra fast-track extubation in heart transplant surgery patients. Int J Crit Illn Inj Sci. 2015;5(2):89–92. doi: 10.4103/2229-5151.158394. - DOI - PMC - PubMed