Predictive score proposal for fast-track following minimally invasive surgical mitral valve repair

Historically, patients undergoing cardiac surgery were administered high-dose, long-lasting, opioid-based anaesthesia and postoperative analgesia. While helping to address the complex needs of early postoperative care of patients, this regimen also contributed to patients being mechanically ventilated for extended periods of time in the intensive care unit before finally being extubated and transferred to the ward 24–48 h following their surgery. Unfortunately, this approach, combined with a rise in patient complexity and an overall increase in the number of patients undergoing cardiac surgery, has led to a greater strain on the healthcare system. Fast‐track cardiac care involves early removal, within 8 h of heart surgery, of the tube that provides mechanical breathing support (called early tracheal extubation) to enable cardiac surgery [1].

Analyses of fast-track processes demonstrated that low-risk cardiac surgical patients require minimal intensive care, with a low incidence of mortality or morbidity. In this context, we read with great interest the article ‘Factors associated with an unsuccessful fast-track course following minimally invasive surgical mitral valve repair’ by Van Praet et al. The authors present the perioperative factors and their association with fast-track failure in a retrospective cohort study of patients undergoing minimally invasive mitral valve surgery. The conclusion of the study reported that the factors associated with fast-track failure in patients with Carpentier type I and II pathologies undergoing minimally invasive mitral valve repair are a New York Heart Association classification III–IV at baseline, pre-existing chronic kidney disease and coronary artery disease. Postoperative bleeding requiring rethoracotomy and procedure time were also identified as important factors associated with failed fast-track [2]. We congratulate the authors on the interesting article and ask them if it could be useful in future perspectives the creation of a score focused on risk factors and intraoperative problems in order to be able to predict a successful fast-track following minimally invasive surgical mitral valve repair.

REFERENCES