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Review
. 2024 May 14;13(10):2903.
doi: 10.3390/jcm13102903.

The Enhanced Recovery after Surgery Approach in Heart Valve Surgery: A Systematic Review of Clinical Studies

Pietro Giorgio Malvindi  1 , Olimpia Bifulco  1 , Paolo Berretta  1 , Michele Galeazzi  1 , Jacopo Alfonsi  1 , Mariano Cefarelli  1 , Carlo Zingaro  1 , Hossein M Zahedi  2 , Christopher Munch  2 , Marco Di Eusanio  1
Affiliations
Review

The Enhanced Recovery after Surgery Approach in Heart Valve Surgery: A Systematic Review of Clinical Studies

Pietro Giorgio Malvindi et al. J Clin Med. .

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols aim to reduce postoperative complications and promote earlier recovery. Although it is well established in noncardiac surgery fields, the ERAS approach has only recently been adopted in cardiac surgery. The aim of this review is to evaluate the status and implementation of ERAS protocols in patients undergoing heart valve surgery and to summarise associated clinical results. Methods: A literature search for the period January 2015 and January 2024 was performed through online databases. Clinical studies (randomised controlled trials and cohort studies) on patients undergoing heart valve surgical procedures and comparing ERAS and conventional approaches were included. The data extracted covered studies and populations characteristics, early outcomes and the features of each ERAS protocol. Results: There were 14 studies that fulfilled the final search criteria and were ultimately included in the review. Overall, 5142 patients were identified in the 14 studies, with 2501 in ERAS groups and 2641 patients who were representative of control groups. Seven experiences exclusively included patients who underwent heart valve surgery. Twelve out of fourteen protocols involved multiple interventions from the preoperative to postoperative phase, while two studies reported actions limited to intraoperative and postoperative care. We found high heterogeneity among the included protocols regarding key actions targeted for improvement and measured outcomes. All the studies showed that ERAS pathways can be safely adopted in cardiac surgery and in most of the experiences were associated with shorter mechanical ventilation time, reduced postoperative opioid use and reduced ICU and hospital stays. Conclusions: As demonstrated in noncardiac surgery, the adoption of structured ERAS protocols has the potential to improve results in patients undergoing heart valve surgery. Further evidence based on larger populations is needed, including more homogenous pathways and reporting further outcomes in terms of patient satisfaction, recovery and quality of life after surgery.

Keywords: ERAS; aortic valve; cardiac surgery; heart valve; minimally invasive cardiac surgery; mitral valve.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Graphical representation of the number of studies including preoperative key actions.
Figure 2
Figure 2
Graphical representation of the number of studies including intraoperative key actions.
Figure 3
Figure 3
Graphical representation of the number of studies including postoperative key actions.
See this image and copyright information in PMC

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